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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 5, September/October 2016
AFRICA
329
the study period were included. This comprised adults over 18
years of age. Cardiovascular admissions, including strokes, were
then extracted. After-hours was considered to be between 16:00
on one day and 08:00 the next day. Weekends were defined as the
period from 16:00 on Friday to 08:00 on Monday. All other times
were defined as weekdays.
Socio-demographic data such as age, gender, ethnicity,
marital status and occupation were captured. Other data such
as day and time of admission, clinical diagnosis, and length of
stay in hospital, as well as outcome of the admission were also
ascertained.
The case definition for cardiovascular disease was any
disorder of the heart and/or blood vessels and included the
following: coronary heart disease, cerebrovascular disease,
peripheral arterial disease, rheumatic heart disease, congenital
heart disease, arrhythmias, deep-vein thrombosis and pulmonary
embolism, and their complications. Ethical clearance was
obtained from the Health Research and Ethics Committee
(HREC) of the UCTH.
Statistical analysis
Data were analysed using STATA V 13.0 (Stata Corp Lp, College
of Station Texas, USA). Continuous variables were presented as
means or median and interquartile ranges (for skewed data),
while categorical variables were presented as percentages. The
chi-squared test was used to test the significance of association
between categorical variables. Continuous variables were also
converted into categorical variables and compared using the
chi-squared test (or Fischer’s exact test where indicated). A
logistic regression model was built to identify covariates of poor
outcome among the patients studied. A
p
-value of
<
0.05 was
regarded as the level of statistical significance.
Results
A total of 339 patients were admitted during the study period
and this accounted for 34.5% of the total medical admissions.
Most (286; 84.4%) of these admissions occurred via the
emergency department while 53 (15.6%) came via the medical
out-patients’ clinic. Females were in the majority (207; 61.1%)
with a male:female ratio of 1:1.05 (
p
=
0.92). The median age of
all participants was 55 years with an interquartile range of 47–65
years. The commonest occupational category among the patients
was skilled non-manual (120; 35.4%), while professional workers
were fewest (7; 2.1%), as shown in Table 1.
With regard to the type of cardiovascular disease (CVD)
diagnosed on presentation to hospital, stroke was most common
(187; 55.2%) and this was closely followed by congestive heart failure
(CHF) in 144 (42.5%) patients. The causes of heart failure included
hypertension (70; 48.6%), dilated cardiomyopathy (51; 35.4%),
rheumatic heart disease (2; 1.4%) and anaemia (21; 14.6%) (Fig. 1).
More patients (257; 75.8%) presented during weekdays
compared with over the weekends, as shown in Table 2. Of
the 339 patients studied, slightly more than half (198; 58.4%)
presented during working hours, while 141 (41.6%) presented
during after-hours. The consultant’s review of the studied
patients tended to occur mostly within two to seven days of
admission (54%) and few patients (23; 6.8%) were reviewed by
Table 1. Socio-demographic characteristics of the subjects
Variable
Frequency
Percentage
Age (years)
<
29
15
4.4
30–39
36
10.6
40–49
47
13.9
50–59
104
30.7
≥
60
137
40.4
Gender
Male
132
38.9
Female
207
61.1
Occupation
Professional
7
2.1
Managerial
53
15.6
Skilled manual
49
14.5
Skilled non-manual
120
35.4
Retired
95
28.0
Student
15
4.4
Hypertension Dilated cardio-
myopathy
Anaemia Rheumatic
heart disease
50
45
40
35
30
25
20
15
10
5
0
48.6
35.4
14.6
1.4
Fig. 1.
Causes of heart failure.
Table 2. Profile of cardiovascular disease/presentation
Variable
Frequency
Percentage
Type of cardiovascular disease
Stroke
187
55.2
Heart failure (CHF)
144
42.5
Arrhythmias
8
2.4
Causes of heart failure
Hypertension
70
48.6
Dilated cardiomyopathy
51
35.4
Anaemia
21
14.6
Rheumatic heart disease
2
1.4
Time of presentation
Weekdays
257
75.8
Weekends
82
24.2
Working hours
198
58.4
After hours
141
41.6
First contact doctor
Consultant
14
4.0
Senior resident
6
1.8
Registrar/house officer
319
98.2
Days to consultant review
≤
1
133
39.2
2–7
183
54.0
>
7
23
6.8
Days admitted
<
14
197
54.4
>
14
152
45.6
CHF: congestive heart failure.