CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 3, July/August 2023 AFRICA 141 Methods This was a retrospective study and involved a review of admission records of all patients admitted into the medical wards of the 760-bed Lagos University Teaching Hospital, Nigeria, between January 2002 and December 2017. The medical wards contribute 116 (15.3%) of the total bed capacity of the hospital. All adult ward admissions are initiated through the adult ER of the hospital and the daily medical out-patient clinics. Patients presenting at the ER are reviewed first by the senior registrar on call while definitive diagnoses are made by the consultant, in line with the hospital policy. These patients are first stabilised in the ER and later transferred to the appropriate speciality wards for proper admission. We reviewed all medical admissions and deaths in the ER and the four medical wards within the period under review. We used the records in the ER to trace the patients to their respective destination wards to avoid duplication of data. We also included patients who were admitted through the medical out-patient clinics that run from Monday to Friday. All patients who were admitted (first admissions and rehospitalisation) to the medical wards during the study period and whose records were documented in the admission and discharge/death registers were included. Trained research assistants were used to retrieve vital information from the admission records/registers. Relevant patient information retrieved for analysis included date of admission, age, gender, initial diagnosis (presenting or admission diagnosis), final diagnosis, date of discharge/death and duration of hospital stay. The final diagnosis was used for computation. In this study, CVD was defined as circulatory diseases that affect the heart and blood vessels, according to the International Classification of Diseases (ICD, 9th revision), the operational ICD at the commencement of the study.21 They included heart failure, hypertensive diseases (HDx) (severely elevated blood pressure and hypertensive encephalopathy), stroke and acute coronary syndrome (ACS). Minor ones were valvular heart disease, pericardial disease, rheumatic diseases and venous thromboembolism. These were grouped together as ‘others’. Statistical analysis Retrieved data were recorded on pre-designed Microsoft 10 Excel spread sheets and analysed using SPSS statistical software version 23.0. Continuous variables are expressed either as mean ± standard deviation (SD) or median and interquartile range (IQR), as appropriate, and categorical data as frequencies and percentages. The independent Student’s t-test and ANOVA were used to compare means while the Mann–Whitney and Kruskal–Wallis tests were used to compare median values. Median survival according to CVD type was compared using the Kaplan–Meier curve and log rank test, respectively. CVD admission rate was derived as a ratio of total CVD admissions to total medical admissions, CVD death rate as the ratio of total CVD deaths to total medical deaths, and CVD case fatality as a ratio of CVD deaths to CVD admissions. For ease of description, the temporal trend in admissions and deaths during the study period was partitioned quadrennially: January 2002 to December 2005, January 2006 to December 2009, January 2010 to December 2013, and January 2014 to December 2017. A p-value < 0.05 was regarded as significant at the 95% confidence interval. Results A total of 21 369 medical admissions were recorded during the period under review and 4 456 (20.8%) were CVD admissions. Males were slightly more predominant at 2 292 (51.4%). The median age of the CVD patients was 56.6 years (IQR 46.0–68.0). The mean age of male and female CVD patients was comparable (56.7 ± 14.3 vs 56.1 ± 15.9 years, p = 0.17). The majority of the patients [2 921 (65.6%)] were within the ages of 40 and 70 years (Table 1). There was a total of 3 582 (16.8%) recorded medical deaths and 1 090 (30.4%) were due to CVD. The majority of the CVD admissions [3 288 (73.8%)] were duly discharged home following clinical improvement while 58 (1.3%) were discharged against medical advice (DAMA). The remaining 1 090 (24.6%) were mortality outcomes (CVD case fatalities). The median length of stay of the CVD admissions was 11 days (IQR 5–21 days: range 1–159 days). Fig. 1 shows the four commonest CVD admission sub-types. Strokes (ischaemic and haemorrhagic) accounted for 2 276 Table 1. Age and gender distribution of CVD admissions (2002–2017) Variable Frequency (n = 4 456) Percentage Age group (years) 18–30 31–40 41–50 51–60 61–70 71–80 > 80 Median (IQR) 233 493 841 1 042 1 038 630 179 56.8 (46.0–68.0) 5.2 11.1 18.9 23.4 23.3 14.1 4.0 Gender Male Female 2 292 2 164 51.4 48.6 Stroke 51% Heart failure 36% HDx 11% ACS 1% Fig. 1. Most frequent CVD sub-types. HDx, hypertensive diseases; ACS, acute coronary syndrome.
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