Cardiovascular Journal of Africa: Vol 29 No 4 (July/August 2018)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 4, July/August 2018 AFRICA 225
Presentation, management and outcomes of acute
coronary syndrome: a registry study from Kenyatta
National Hospital in Nairobi, Kenya
Ehete Bahiru, Tecla Temu, Bernard Gitura, Carey Farquhar, Mark D Huffman, Frederick Bukachi
Abstract
Background: Acute coronary syndrome (ACS) is under-
studied in sub-Saharan Africa despite its increasing disease
burden. We sought to create an ACS registry at Kenyatta
National Hospital to evaluate the presentation, management
and outcomes of ACS patients.
Methods: From November 2016 to April 2017, we conducted
a retrospective review of ACS cases managed at Kenyatta
National Hospital between 2013 and 2016, with a prima-
ry discharge diagnosis of ACS, based on International
Classification of Diseases (ICD) 10 coding (I20-I24). We
compared the presentation, management and outcomes by
ACS subtype using analysis of variance testing. We created
multivariable logistic regression models using the Global
Registry of Acute Coronary Events (GRACE) risk score to
evaluate the association between clinical variables, including
guideline-directed medical therapy and in-hospital outcomes.
Results: Among 196 ACS admissions, the majority (65%)
was male, and the median age was 58 years. Most (57%)
ACSadmissions were for ST-segment-elevation myocardial
infarction (STEMI). In-hospital dual antiplatelet (> 85%),
beta-blockade (72%) and anticoagulant (72%) therapy was
common. A minority (33%) of patients with STEMI was
eligible for reperfusion therapy but only 5% received reperfu-
sion. In-hospital mortality rate was 17%, and highest among
individuals presenting with STEMI (21%). After multivariable
adjustment, higher serum creatinine level was associated with
higher odds of in-hospital death (OR = 1.84, 95% CI: 1.21–
2.78), and STEMI and Killip class > 1 were associated with
in-hospital composite of death, re-infarction, stroke, major
bleeding or cardiac arrest (STEMI: OR = 8.70, 95% CI:
2.52–29.93; Killip > 1: OR = 10.7, 95% CI: 3.34–34.6).
Conclusions: We describe the largest ACS registry at Kenyatta
National Hospital to date and identify potential areas for
improved ACS care related to diagnostics and management
to optimise in-hospital outcomes.
Keywords: acute coronary syndrome, sub-Saharan Africa, global
health
Submitted 29/5/17, accepted 11/3/18
Published online 24/5/18
Cardiovasc J Afr 2018; 29: 225–230
DOI: 10.5830/CVJA-2018-017
Sub-Saharan Africa is increasingly facing a dual disease burden
of infectious and non-communicable chronic diseases (NCDs),
including ischaemic heart disease, which is the leading cause
of deaths globally. 1 The prevalence of ischaemic heart disease
is steadily rising in sub-Saharan Africa due to the increasing
prevalence of risk factors, including diabetes, obesity, smoking,
physical inactivity, hypertension and dyslipidaemia in the context
of urbanisation and globalisation.1 The prevalence and mortality
rates of ischaemic heart disease in sub-Saharan Africa are
predicted to rise by 70% in African men and 74% in African
women by 2030. 2
While the increasing burden of ischaemic heart disease in
sub-Saharan Africa is recognised, few studies have evaluated the
presentation, management and outcomes of acute manifestations
of ischaemic heart disease, such as acute coronary syndrome
(ACS). Accurate and timely assessment of ACS disease burden
and current management trends in sub-Saharan Africa can
help national and regional healthcare systems build capacity to
respond appropriately to the rising epidemic of ischaemic heart
disease in the region.3
Internationally, ACS registries have been valuable in studying
the presentation, management and outcomes of patients for
quality-improvement purposes.3 Data from large ACS registries
in sub-Saharan Africa are limited, particularly public hospitals in
Kenya. Societies such as the Pan-African Society of Cardiology
(PASCAR) have recognised the need for improved understanding
of ACS in the region and are advocating for initiatives including
large-scale ACS registries.4
To improve current understanding of ACS management
in Kenya, we sought to create an ACS registry at Kenyatta
Northern Pacific Global Health Research Fellowship
Training Consortium, University of Washington, Seattle,
WA, and Division of Cardiology, Department of Medicine,
David Geffen School of Medicine, University of California,
Los Angeles, USA
Ehete Bahiru, MD,
Department of Preventive Medicine, Northwestern
University, Chicago, IL, USA
Mark D Huffman, MD, MPH
Department of Global Health, University of Washington,
Seattle, WA, USA
Tecla Temu, MD, PhD
Kenyatta National Hospital, Division of Cardiology,
Department of Medicine, Nairobi, Kenya
Bernard Gitura, MB ChB, MMed, FACC
Departments of Global Health, Epidemiology and Medicine,
University of Washington, Seattle, WA, USA
Carey Farquhar, MD, MPH
Department of Medical Physiology, University of Nairobi,
Nairobi, Kenya
Frederick Bukachi, MB ChB, MMed, PhD