CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 3, July/August 2023 142 AFRICA (51.1%) of the total CVD admissions and 10.6% of all medical admissions during this period. Heart failure contributed 1 606 (36.0%) and 7.5% of all CVD and medical admissions, respectively, during this period. There was a cumulative increase in the number of CVD admissions and deaths (ptrend < 0.001, respectively) every four years over the period under review (Fig. 2, Table 2). The quadrennial cumulative CVD admissions between 2002 and 2005 were 468. This rose to 1 490 at the end of 2009, representing a 201.1% increase, and it further rose to 2 883 at the end the of 2013, representing a 516.0% increase. By the end of 2017, total CVD admissions stood at 4 436, representing an 847.9% increase (Table 2). CVD deaths followed a similar quadrennial pattern. Cumulative CVD deaths between 2002 and 2005 were 116. This rose to 243 by the end of 2009, representing an increase of 109.5%. It rose further to 666 by the end of 2013, an increase of 474.1%. By the end of 2017, total CVD deaths stood at 1 090, representing an increase of 836.6%. Although the absolute number of CVD deaths increased exponentially over the study period, increase in CVD case-fatality rates was rather subtle from 22.0 to 25.9%, with an average of 24.5% for the study period (Table 2). The temporal trends in admissions and deaths were similar in males and females (Fig. 3). However, with regard to the case-fatality ratios, there was an increasing trend in males and a decreasing trend in females (Table 2). Stroke, heart failure, HDx and ACS constituted 51.2, 36.2, 11.3 and 1.6% of all CVD admissions, respectively. Stroke patients were predominantly male, older, had the shortest length of hospital stay and had the highest mortality rate compared to the other CVD cases (Table 3). Heart failure patients were predominantly female and had the longest length of hospital stay. However HDx and ACS had the best outcomes, with an average of 90% discharge rate (Table 3). Table 2. Quadrilinear distribution of CVD admissions and deaths (2002–2017) Year Medical CVD Male (n = 2 292) Female (n = 2 164) Adm Death Adm, n (%) Death, n (%) CFR (%) CVD adm CVD death CFR (%) CVD adm CVD death CFR (%) 2002–2005 4 216 411 468 (11.1) 116 (28.2) 24.7 316 64 20.2 172 54 31.4 2006–2009 5 101 982 941 (18.5) 243 (24.8) 25.8 522 137 26.2 419 106 25.3 2010–2013 6 608 895 1 393 (21.1) 307 (34.3) 22.0 644 134 20.8 749 173 23.1 2014–2017 5 444 1 294 1 634 (30.0) 424 (32.8) 25.9 810 230 28.4 824 194 23.5 Total 21 369 3 582 4 436 (20.8) 1 090 (30.4) 24.5 2 292 565 26.6 2 164 527 24.3 p < 0.001. Adm, admission; CVD, cardiovascular disease; CFR, case-fatality rate. 2002–2005 2006–2009 2010–2013 2014–2017 Absolute counts 1 800 1 350 900 450 0 Ptrend < 0.001 (CVD admissions and deaths) 468 941 1 393 1 634 424 307 243 116 CVD deaths CVD admissions 2002–2005 2006–2009 2010–2013 2014–2017 Percentage 40 30 20 10 0 CVD deaths CVD admissions Fig. 2. A. Quadrilinear trend in CVD admissions and deaths from 2002–2017 (absolute counts). B. Quadrilinear trend in CVD admissions and deaths from 2002–2017 (in percentages). A B 2002–2005 2006–2009 2010–2013 2014–2017 Absolute counts 900 675 450 225 0 CVD admissions (male) CVD admissions (female) CVD deaths (male) CVD deaths (female) Ptrend < 0.001 Fig. 3. Quadrilinear trend in CVD admissions and deaths in males and females from 2002–2017.
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