Cardiovascular Journal of Africa: Vol 32 No 5 (SEPTEMBER/OCTOBER 2021)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 5, September/October 2021 238 AFRICA and semi-urban under-resourced provinces such as the Eastern Cape, Free State and Limpopo. Whereas a few recent studies from large urban tertiary-care centres in South Africa suggest that cardiovascular disease (CVD) is a growing cause for hospital admissions, similar data from the rest of the country are sparse. 6,7 In a prospective study of admissions to one of Gauteng’s largest hospitals, 11% of the medicine in-patients at Baragwanath Hospital were admitted under the care of the Department of Cardiology, with 44% of them receiving a diagnosis of heart failure. 6 Elsewhere, in a retrospective review and analysis of in-patient mortality at a large urban tertiary-care centre in the Western Cape, admissions to the cardiology ward constituted 12 to 16% of the hospital admissions at Groote Schuur Hospital over the five years under scrutiny. 7 It is not known whether information like this can be extrapolated to reflect the burden of CVD admissions in rural and semi-urban hospitals. Such information would be important to help with priority setting, healthcare resource allocation and health infrastructural planning. We therefore conducted a retrospective review of the hospital records at a district hospital in the semi-rural province of the Eastern Cape to assess the prevalence, spectrum and outcomes of CVD between 1 April and 31 October 2016. Methods A primary diagnosis is defined in the International Classification of Disease version 10 (ICD-10) as that condition established to be chiefly responsible for occasioning the admission of the patient to the hospital for care. 8 CVD are defined by the World Health Organisation (WHO) and the Global Burden of Disease (GBD) as disorders of the heart and blood vessels and include coronary artery disease (CAD), cerebrovascular accidents (strokes), rheumatic heart disease, congenital heart disease, endocarditis, cardiomyopathies, myocarditis, hypertensive heart disease, atrial fibrillation and flutter, and non-rheumatic valvular heart diseases. 9-12 For this study, we excluded peripheral vascular disease because access to records for patients with this diagnosis was limited. Dora Nginza is a district hospital located in Zwide township in the Nelson Mandela Bay Municipality (Port Elizabeth), South Africa. Nelson Mandela Bay has a population of 1 152 115 and a 36.6% unemployment rate. 13 The Department of Internal Medicine has 120 beds with no intensive care or high care units and limited access to radiological imaging other than plain chest radiography. We conducted a retrospective review of the hospital records for patients admitted to the Department of Internal Medicine at Dora Nginza Hospital. The patients’ records, National Health Laboratory Services (NHLS) data, available imaging and death records of all patients admitted to the unit between 1 April and 31 October 2016 were reviewed. During the seven-month study period, Dora Nginza Hospital had four qualified specialist physicians responsible for the clinical assessments, diagnoses and management of patients. These physicians were responsible for making the ICD-10 diagnoses for all patients admitted to the Department of Medicine. A standardised data-collection form was used to capture demographic data, dates of admission and discharge, primary diagnoses and background medical problems. This study focused on patients who received a primary diagnosis of CVD. Patients with missing information on the primary diagnosis and outcome or missing patient records were excluded from the analysis. The study was approved by the Hospital Research Ethics Board (HREC 014/2018). Statistical analysis Results of normally distributed quantitative measurements are reported as means and standard deviations (SD) while skewed data are reported as median and interquartile range (IQR). Categorical variables are represented as number and percentage. Pearson’s chi-squared or Fisher’s exact tests were used for comparing the relative frequency of characteristics between the group with the primary diagnosis of CVD and the rest of Table 1. Patient characteristics and background medical history Variable Cardiovascular disease ( n = 1325) Non-cardiovascu- lar disease ( n = 3559) p -value Age (years) # 60 (15) 43 (17) < 0.0001 Female, n (%) 867 (65.4) 1860 (52.3) < 0.0001 Hypertension, n (%) 1250 (94.3) 716 (20.1) < 0.0001 Diabetes mellitus, n (%) 408 (30.8) 441(12.4) < 0.0001 HIV infection, n (%) 138 (10.4) 1632 (45.9) < 0.0001 Duration of hospital stay* 3 (1–6) 3 (1–7) In-hospital mortality, n (%) 174 (13.1) 571 (16.0) 0.001 # Mean (SD), * median (IQR). TB pericarditis Hypertensive urgency or emergency Hypertensive heart disease in heart failure RHD ACS Stroke Congenital heart defects Pulmonary hypertension Cardiac arrhythmia Peripartum cardiomyopathy 38.42% 4.53% 1.96% 18.04% 33.28% 1.43% Fig. 1. Pie chart of CVD as a primary diagnosis at Dora Nginza Hospital from 1 April to 31 October 2016. RHD, rheumatic heart disease; ACS, acute coronary syndrome; TB, tuberculosis.