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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 5, September/October 2016
330
AFRICA
consultants more than seven days after admission, as shown in
Table 2. In 4% of all patients studied, a consultant was the first
contact doctor. More patients (54.4%) were admitted for less
than 14 days, compared with those admitted for a longer time.
Bivariate analysis revealed that being over 55 years of age,
type of CVD, rheumatic heart disease and anaemia as causes
of heart failure, as well as duration of hospitalisation were
significantly associated with poor outcome (
p
<
0.05), as shown
in Table 3. Further subgroup analysis revealed that patients with
CHF had a higher risk of a poor outcome compared with those
who had CVD due to stroke or arrhythmias. Variables that were
not significantly associated with poor outcome were gender,
status of first contact doctor, mode of admission, time of day
seen, day of presentation and promptness of consultant’s review.
A logistic regression model was built using seven variables, as
show in Table 4. Presentation to hospital during after-hours and
hospital stay of more than 14 days were significant predictors
of poor outcome. Those who presented to hospital after hours
were three times more likely to have a poor outcome, compared
to those who presented within regular working hours. Also,
patients who were admitted for more than 14 days had a greater
likelihood of having a poor outcome, compared with those who
spent less than 14 days in hospital.
Discussion
This study has shown that most patients with CVD presenting
at our centre in a developing country were in the sixth decade
of life, which is two decades earlier than the typical presentation
in developed countries. This corroborates the findings of the
INTERHEART Africa study.
12
Most of the patients were in the lower middle class (skilled
non-manual), the so called ‘urban poor’, who have absorbed
the Western lifestyle as a status symbol, an indication of the
epidemiological transition currently taking place in this region.
There were fewer professionals, in the higher socio-economic
class, and this could have been attributed to their better
awareness of cardiovascular risk factors and the adoption of
healthy lifestyles, or better compliance with their medication.
Another reason may have been that professionals do not
commonly use public hospitals such as the one in which this
study was carried out.
The majority of the patients presented with stroke and this
corroborates the findings in other studies, which have shown
that stroke is more common in black hypertensives than in
non-blacks,
13,14
and that the risk of a first stroke is about twice
as high in blacks as in whites.
15
Stroke has been identified as a
major health problem in Nigeria,
16-18
which could be linked to a
Table 3. Bivariate analysis of variables with regard to poor outcome
Variable
Died (%)
Discharged/ referred
LAMA (%)
Chi-squared test
p
-value
Age (years)
≤
55
29 (16.1)
129 (71.7)
22 (12.2)
6.17
0.04*
>
55
43 (27.0)
101 (63.5)
15 (9.4)
Gender
Male
28 (21.2)
91 (68.9)
13 (9.8)
0.26
0.88
Female
44 (21.3)
139 (67.1)
24 (11.6)
Type of CVD
Heart failure (CHF)
18 (12.5)
110 (76.4)
16 (11.5)
15.6
0.004*
Stroke
54 (28.9)
113 (60.4)
20 (10.7)
Arrhythmias
0 (0)
7 (87.5)
1 (12.5)
First contact doctor
Consultant
2 (14.3)
11 (78.6)
1 (1.7)
3.75
0.23
Senior resident
0 (0)
6 (100)
0 (0)
Registrar/HO
70 (21.9)
213 (66.8)
36 (11.3)
Admission route
ED
64 (22.4)
189 (66.1)
33 (11.5)
2.75
0.25
MOPD
8 (15.1)
41 (77.4)
4 (7.5)
Time seen
After hours
35 (24.8)
89 (63.1)
17 (12.1)
2.53
0.28
Working hours
37 (18.7)
141 (71.2)
20 (10.1)
Presented
Weekday
55 (21.4)
173 (67.3)
29 (11.3)
0.19
0.91
Weekend
17 (20.7)
57 (69.5)
8 (9.8)
Consultant’s review
≤
1 day
35 (26.3)
81 (60.9)
17 (12.8)
4.91
0.09
>
1 day
37 (18.0)
149 (72.3)
20 (9.7)
Days admitted
≤
14
56 (28.4)
113 (57.4)
28 (14.2)
23.8
<
0.001*
>
14
16 (11.3)
117 (82.4)
9 (6.3)
Heart failure causes (
n
=
144)
Hypertension
9 (12.8)
55 (78.6)
6 (8.6)
Dilated cardiomyopathy
1 (2.0)
44 (86.2)
6 (11.8)
Rheumatic heart disease
1 (50.0)
1 (50.0)
0 (0)
18.7
0.004*
Anaemia
7 (33.4)
10 (47.6)
4 (19.0)
LAMA: left against medical advice, ED: emergency department, MOPD: medical out-patients’ department.