Burden of cardiovascular disease in Sub-Saharan Africa, 1990-2019: An analysis of the Global Burden of Disease Study

INTRODUCTION

The rise in cardiovascular disease (CVD) in Sub-Saharan Africa (SSA) reflects a major shift from communicable to noncommunicable diseases as primary health challenges. Consequently, this study aims to explore the burden of CVD and associated risk factors in SSA using data from the Global Burden of Disease (GBD) database.

METHODS

This study utilized data from the GBD 1990 to 2019 to examine CVD prevalence in 46 SSA countries. We employed Bayesian regression models, demographic techniques, and mortality-to-incidence ratios to analyze both prevalence and mortality rates. Additionally, disability-adjusted life years (DALYs) were computed, and various risk factors were examined using the GBD's comparative risk assessment framework.

RESULTS

Between 1990 and 2019, CVD raw counts in SSA rose by 131.7 %, with a 2.1 % increase in age-standardized prevalence rates. The most prevalent conditions were ischemic heart disease, stroke, and rheumatic heart disease. During the same period, the age-standardized CVD deaths per 100,000 individuals decreased from 314 (1990) to 269 (2019), reflecting a -14.4 % decline. Age-standardized CVD DALY rates also showed a decrease from 6,755 in 1990 to 5,476 in 2019, with translates to 18.9 % reduction. By 2019, the Central African Republic, Madagascar, and Lesotho were the countries with the highest age-standardized DALY rates for all CVDs.

CONCLUSIONS

The study highlights a contrasting trend in SSA's CVD landscape: a decrease in age-standardized mortality and DALYs contrasts with increasing CVD prevalence, emphasizing the need for targeted public health strategies that balance treatment advancements with intensified prevention and control measures.

Abstract P053: Causes And Predictors Of Readmission In Hypertensive Emergency - A Nationwide Inpatient Analysis

Introduction: Hypertensive emergency (HE) is a common medical emergency requiring inpatient admission. Our aim was to characterize HE patient demographics and analyze the factors that increases the likelihood for HE readmissions.

Methods: This was a retrospective cohort study using the 2019 Nationwide Readmissions Database to identify admissions in adults with a diagnosis HE. Regression models were used. Primary outcome was all-cause 30-day readmission rate, mortality rate, causes and predictors for readmission.

Results: Out of a total of 56,648 admissions with HE, 7,753 were readmitted, with a readmission rate of 13.72%. The most common causes for readmissions were CHF exacerbation in setting of CKD stage 1-5 11.51% (892 of 7753), hypertensive emergency 11.48% (890 of 7753), hypertensive urgency 7.92% (614 of 7753), AKI 4.67% (362 of 7753), Sepsis 3.12% (241 of 7753), NSTEMI 2.44% (189 of 7753), and ischemic CVA 1.79% (139 of 7753). Compared to index admissions, readmissions had higher mortality rate (1.39% vs 0.35%), LOS (5.13 days vs 3.65 days), and total charge ($58,172.50 vs $42,273.43). See table 1 for index admission group demographics. The top predictors for readmissions were, reported in odds ratio, ESRD 3.43, hypertension 2.30, discharged AMA 2.29, diabetes mellitus 1.92, transfer to nursing facility 1.5, drug abuse 1.40, depression 1.28.

Conclusion: HE has a high readmission rate of 13.72% with the most common cause for readmission being CHF exacerbation, followed by recurrence of HE, AKI, sepsis, NSTEMI, and ischemic CVA. The best predictor for HE readmission was ESRD, followed by hypertension, discharged AMA, and diabetes mellitus.

Abstract P052: Recurrent Major Depressive Disorder And Hypertension - A Nationwide Analysis Of Patient Demographics And In-hospital Outcomes

Introduction: Hypertension (HTN) is a condition that contributes significantly cardiovascular disease. Little is known about the effect of recurrent major depressive disorder (rMDD) on HTN.

Methods: This was a retrospective cohort study using the Nationwide Inpatient Sample database to identify admissions in adults with a diagnosis of HTN and rMDD in 2019. Regression models were adjusted for demographic variables and hospital characteristics. Primary outcome was all-cause mortality, and secondary outcomes were length of stay (LOS) and total charge in USD.

Results: Out of 9,582,450 admissions with hypertension, 114,480 had rMDD. Compared to Non-rMDD-HTN cohort, rMDD-HTN cohort had more females, younger age, White, Medicaid, private insured, self-pay, median household income, and fewer Black, Hispanic, API , highest household income. rMDD-HTN cohort had more AIDS, alcohol abuse, drug abuse, chronic pulmonary disease, and less arthropathies, dementia, PVD, and diabetes mellitus. rMDD-HTN cohort had lower all-cause mortality rate (0.40% vs 1.70%,p<0.001), all-cause lower mortality OR 0.38 (95%CI 0.30-0.47,p<0.001), longer mean LOS of 1.90 days (95%CI 1.74-2.05,p<0.001) with mean LOS of 6.73 days vs 4.63 days, and total hospitalization charge -$15,428.93 (95%CI -$16,964.47- -$13,893.38,p<0.001).

Conclusion: In patients admitted with HTN, the presence of rMDD was associated with a lower all-cause mortality rate, lower odds of all-cause mortality, longer LOS, and lower total hospitalization charge. rMDD was associated with more female, younger age, White, Medicaid as well as higher prevalence of AIDS, alcohol abuse, drug abuse and chronic pulmonary disease.

Staphylococcus aureus native mitral valve endocarditis associated with bed bug bites - A case report and review of the literature

Staphylococcus aureus is a leading cause of community acquired bacteremia and infective endocarditis. S. aureus is a part of the normal skin flora in approximately one third of the human population. Infective endocarditis due to S. aureus can cause several complications and is associated with increased mortality. A 48-year-old female with no significant medical history presented with S. aureus bacteremia and native mitral valve endocarditis. Multiple cutaneous skin lesions were identified, which she reported were due to recent bed bug bites. No source of infection was found except for the skin lesions. Her hospital course was complicated by pulmonary and cerebral septic emboli, left pleural empyema, and acute renal injury. We suspected the bed bug skin bites were the most likely source of bacteremia. Bed bugs carry many human pathogens but have not been shown to be a competent vector. We did not find any literature on endocarditis associated with bed bug bites; thus, our case will be a novel finding.

Teenager Presenting With Chest Pain and ST-Segment Changes on Electrocardiogram After SARS-CoV-2 Illness: Early Repolarization vs. Acute Pericarditis

The ST-segment elevation is commonly associated with acute myocardial Infarction. However, there are other non-ischemic causes of ST-elevation. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly contagious illness that continues to plague the world since the first case was reported in China over two years ago. As cases of the diseases become rampant, we have learned more of its complications which can include cardiac and pericardial disease. We present a case report of a young African American male who presented with chest pain six weeks after being diagnosed with SARS-Cov-2 pneumonia. Electrocardiogram (EKG) showed ST-segment changes that were initially presumed to be acute pericarditis. The patient was initially treated with colchicine. After further workup and a second opinion, ST-segment changes were thought to be likely benign early repolarization changes rather than pericarditis. Differential diagnosis of ST-segment changes on EKG in the patient with chest pain is broad. Subtle findings on EKG are important in distinguishing these differentials and should be well known and understood.

Rare case of pancrelipase therapy-induced neutropaenia

A 61-year-old man was transferred to our facility from an outside hospital due to refractory neutropaenia of unknown aetiology. The patient presented to the referring hospital with a 5-day history of worsening diarrhoea and abdominal pain. Initial lab results at presentation showed severe neutropaenia with an absolute neutrophil count of 0. Investigations included a bone marrow biopsy which showed slightly hypocellular marrow with near absence of granulocytic precursors. A CT without contrast showed evidence of chronic pancreatitis and acute colitis. The patient's neutropaenia persisted despite granulocyte colony-stimulating factor therapy. The patient was, thus, transferred to our facility for a higher level of care. At our facility, the patient had rapid correction of neutropaenia after discontinuation of pancrelipase therapy. The patient's abdominal pain and diarrhoea also improved while off pancrelipase. Neutropaenia has completely resolved 6 weeks after discharge without any further therapy.