CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 3, July/August 2023 140 AFRICA Trends and outcomes of cardiovascular disease admissions in Lagos, Nigeria: a 16-year review Amam C Mbakwem, Casmir Ezenwa Amadi, Jayne N Ajuluchukwu, Oyewole A Kushimo Abstract Background: Cardiovascular disease (CVD)-related admissions are on the increase in Nigeria and the rest of Africa. This study was carried out to highlight the burden, patterns and outcomes of CVD admissions in a tertiary hospital over a 16-year period in Lagos, Nigeria. Methods: Admissions records of patients admitted into the medical wards within the study period (January 2002 to December 2017) were reviewed and relevant information pertaining to the study objectives was retrieved for analysis. Results: There were a total of 21 369 medical admissions and 4 456 (20.8%) CVD-related admissions. A total of 3 582 medical deaths were recorded and 1 090 (30.4%) CVD-related deaths. The median age of the patients was 56.6 (46.0–68.0) years and 51.4% of these were males. Stroke, heart failure, hypertensive disease and acute coronary syndrome constituted 51.2, 36.2, 11.3 and 1.6% of all CVD admissions, respectively. There was a cumulative increase in the number of CVD admissions and deaths (p < 0.001, respectively) during the period under review. Conclusion: CVD admissions are not only common in Nigeria, but there was also a temporal exponential increase in both the admission and death rates, most likely reflecting the epidemiological transition in Nigeria. Keywords: CVD admissions, temporal patterns, stroke, heart failure Submitted 5/10/21, accepted 2/7/22 Published online 30/8/22 Cardiovasc J Afr 2023; 34: 140–148 www.cvja.co.za DOI: 10.5830/CVJA-2022-037 Cardiovascular disease (CVD), typified by stroke, coronary heart disease and heart failure, is a pre-eminent and preventable cause of death globally, accounting for an estimated 29% of all deaths.1 Over 80% of the global burden of CVD is borne by the low- and middle-income countries (LMICs). This burden of CVD is on a backdrop of the perennial high prevalence of infectious diseases and poverty-related morbidities and mortalities in these regions, constituting a double burden of disease profile.2,3 It is believed that by 2030, CVD and non-communicable diseases will be the dominant conditions in these countries.4 The rising prevalence of CVD in these LMICs is fuelled by rapid urbanisation and westernisation and its corollary of globalisation of risks (unhealthy lifestyles): increased consumption of saturated fats and sugars, high salt intake, increasing physical inactivity, smoking and unhealthy use of alcohol. These unhealthy behaviours predispose to the development of biological risk factors for CVD, such as obesity, hypertension, diabetes and dyslipidaemia.4-6 The consequence is a rising burden of CVD. In high-income countries (HIC), CVD remains the greatest contributor to mortality. However, the incidence has either plateaued or has assumed a downward trend over the past half century.7,8 This has been attributed to the success of public health policies and regulation to reduce exposure to a range of risk factors for CVD, improved medical management of these risk factors, opportunistic screening to detect asymptomatic disease, emergency care and treatment.9-11 Data in the published literature show that CVD-related admissions are quite rife, constituting about 31% of all medical admissions in the USA, with ischaemic heart disease being the major cause of admission.12 In Saudi Arabia, CVDs constitute 34.4% of hospital admissions, with stroke being the leading cause.13 In Africa about one-tenth of all medical admissions are CVD related and stroke and heart failure are the major causes.14,15 In Nigeria, studies have shown that CVD-related admissions constitute about 20% of all medical admissions.16-18 However, these studies reviewed hospital admission records spanning a few years and did not demonstrate the temporal trends in these admissions and their outcomes. In essence there is limited knowledge of CVD burden and trajectories in Nigeria. Lagos is cosmopolitan in outlook and a microcosm of Nigeria. It is the country’s economic hub and is home to over 17 million people, about 10% of the Nigerian population.19 Nigeria, like several countries in LMICs, is going through epidemiological transition characterised by the rising burden of non-communicable diseases, including CVD. There are anecdotal reports that CVD admissions are quite common in Lagos. An earlier study in the same hospital looking at hypertension-related emergency room (ER) deaths over a 20-year period showed that stroke and heart failure were the major contributors.20 However, their patterns, temporal trends and outcomes have not been well characterised. Hence the necessity to study the pattern of CVD admissions and outcomes at the Lagos University Teaching Hospital, Nigeria, over a 16-year period. Ethics approval (reference number: ADM/DCST/HREC/889) for the study was obtained from the Health Research ethics committee of the hospital. College of Medicine, University of Lagos, Lagos, Nigeria Casmir Ezenwa Amadi, MD, acetalx@yahoo.com Amam C Mbakwem, MD Jayne N Ajuluchukwu, MD Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria Oyewole A Kushimo, MD
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