CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 3, July/August 2023 AFRICA 143 There was a total of 2 276 stroke admissions, constituting 51.2% of all CVD admissions. The mean age of stroke patients was 59.3 ± 13.6 years, with 1 188 (52.2%) of them being between the ages of 30 and 60 years. There was a male preponderance of 1 194 (52.4%). The mean ages of male and female stroke patients were comparable (58.9 ± 13.1 vs 59.7 ± 13.9 years, respectively, p = 0.16). Ischaemic stroke constituted 86.3% of all stroke admissions. There was no gender difference in ischaemic and haemorrhagic stroke sub-types (p = 0.75). Outcomes (discharge and deaths) were different for the two sub-types. The mortality rates for both ischaemic and haemorrhagic sub-types were 34.1 and 45.8%, respectively (p < 0.0001). The median length of hospital stay for the sub-types were 11 and seven days, respectively (p < 0.001) (Table 4). Stroke admissions increased steadily during the period under review. There were 261 stroke admissions between 2002 and 2005. This rose to 735 by the end of 2009, accounting for an increase of 181.6%. Cumulative stroke admissions rose to 1 373 between 2010 and 2013, representing an increase of 426.0%. Total stroke admissions by the end of 2017 stood at 2 276, representing a 772.0% increase. Deaths from stroke followed this same trend (Table 5, Fig. 4). Death from strokes stood at 92 by the end of 2005. It rose to 175 by the end of 2009, accounting for a 90.2% increase. Cumulative stroke death was 489 (a 431.5% increase) by the 2013 and 812 (a 782.6% increase) by the end of 2017. Heart failure constituted 1 606 (36.2%) of all CVD admissions, with a population mean age of 53.1 ± 16.6 years, and 875 (54.4%) of them were between the ages of 30 and 60 years. Females were more predominant at 844 (52.6%) and younger (51.6 ± 17.0 vs 54.7 ± 15.0 years, respectively, p < 0.001). The three major causes of heart failure were HDx, dilated cardiomyopathy (DCM) and peripartal cardiomyopathy (PPCM) (Table 6). The mortality rate from heart failure admissions was 14.0%, with HDx contributing most (45.5%) (Table 6). The median length of stay for heart failure admissions was 13.0 days (IQR 7.0–22.0 days). Length of stay was comparable in both genders (p = 0.38) and between the sub-types of heart failure aetiologies (p = 0.87). Quadrennial cumulative heart failure admission rates rose from 95 at the end of 2005 to 411 by the end of 2009, Table 3. General pattern, demography and outcomes of major CVD admissions and outcomes (2002–2017) CVD type n (%) Median age (IQR) Gender p-value LOHS n (IQR) p-value Outcome p-value Male n (%) Female n (%) Discharge n (%) DAMA n (%) Death n (%) Stroke 2 276 (51.1) 60.0 (50.0–70.0) 1 192 (52.4) 1 084 (47.6) < 0.001* 10.0 (4.0–23.0) < 0.001** 1 412 (62.0) 52 (2.3) 812 (35.7) < 0.001*** HF 1 606 (36.0) 53.0 (40.0–65.0) 762 (47.4) 844 (52.6) 13.0 (7.0–22.0) 1 363 (84.9) 19 (1.2) 224 (13.9) HDx 502 (11.3) 53.0 (44.5–64.0) 296 (59.0) 206 (41.0) 12.0 (5.0, 21.0) 446 (89.2) 5 (1.0) 49 (9.8) ACS 72 (1.6) 53.0 (44.5-64.0) 42 (58.3) 30 (41.7) 12.0 (7.0, 16) 65 (90.3) 0 (0.0) 7 (9.7) *ANOVA, **Kruskal–Wallis, ***chi-squared test. CVD, cardiovascular disease; SD, standard deviation; HF, heart failure; HDx, hypertensive diseases; ACS, acute coronary syndrome; LOHS, length of hospital stay; IQR, interquartile range; DAMA, discharged against medical advice. Table 4. Patterns of stroke admissions and outcomes (2002–2017) Stroke type n (%) Gender p- value** Age, median (IQR) Gender p- value# LOHS, median (IQR) p- value*** Outcome p- value** Male n (%) Female n (%) Male median (IQR) Female median (IQR) Discharged n (%) DAMA n (%) Death n (%) Stroke 2 276 (100.0) 1 192 (52.4) 1 084 (47.6) 0.769 60 (50–70) 60 (50–69) 60 (50–70) 0.16 10 (4.0–23.0) 0.001* 1 412 (62.0) 52 (2.3) 812 (35.7) 0.001* Haemorrhagic 312 (13.7) 161 (51.6) 151 (48.4) 58 (47–68) 55 (45–67) 58 (48–70) 0.44 7.0 (2.0–16) 155 (49.7) 14 (4.5) 143 (45.8) Ischaemic 1 964 (86.3) 1 031 (52.5) 933 (47.5) 60 (50–70) 60 (50–69) 60 (50–70) 0.22 11.0 (4.0–23) 1 257 (64.0) 38 (1.9) 669 (34.1) *Significant; **chi-squared test; #ANOVA; ***Kruskal–Wallis test. SD, standard deviation; LOHS, length of hospital stay; IOR, interquartile range; DAMA, discharged against medical advice. Table 5. Quadrilinear distribution of the admissions and deaths of the major CVD sub-types (2002–2017) Year Stroke Heart failure HDx ACS Adm Death Adm Death Adm Death Adm Death 2002–2005 261 92 (35.3) 95 8 (8.4) 127 18 (14.2) 5 0 (0.0) 2006–2009 474 175 (36.9) 316 49 (15.5) 141 17 (12.1) 10 2 (20.0) 2010–2013 683 222 (32.5) 535 78 (14.6) 145 5 (3.5) 30 2 (6.7) 2014–2017 858 323 (37.7) 660 89 (13.5) 89 9 (10.1) 27 3 (11.1) Total 2 276 812 (35.7) 1 606 224 (13.9) 502 49 (9.8) 72 7 (9.7) HDx, hypertensive disease; ACS, acute coronary syndrome; Adm, admission. 2002–2005 2006–2009 2010–2013 2014–2017 Frequency 900 800 700 600 500 400 300 200 100 0 Stroke admissions HDx admissions Stroke deaths HDx deaths Heart failure admissions ACS admissions Heart failure deaths ACS deaths Fig. 4. Temporal trends in CVD admissions sub-types and deaths (2002–2017).
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