CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 3, July/August 2023 144 AFRICA representing a 332.6% increase. It rose further to 946 (895.8%) by the end of 2013, and to 1 606 (a 1 590.5% increase) by the end of 2017. (Table 5, Fig. 4). Quadrennial cumulative heart failure deaths stood at eight by the end of 2005; 57 (a 612.5% increase) by the end 2009; 135 (a 1 578.5% increase) by the end of 2013 and 224 (a 2 700% increase) by the end of 2017 (Table 4, Fig. 4). HDx constituted 502 (11.3%) of all CVD admissions, with comparable male and female mean ages (53.55 ± 14.7 and 54.98 ± 16.8 years, p = 0.32) (Table 3). Males were in the majority (59%). About 55.2% of them were between the ages of 30 and 60 years. The mortality rate was similar in both genders; 10.5 and 8.7% for males and females, respectively (p = 0.13). The median length of hospital stay was comparable in both genders, namely 11.0 (5.0–17.0) days and 12.0 (7.0–19.0) days for males and females, respectively (p = 0.07). Cumulative HDx admissions rose from 127 by the end of 2005 to 268 (a 111.0% increase) by the end of 2009; 413 (a 225.2% increase) by the end of 2013, and 502 (a 295.3% increase) by the end of 2017 (Table 5, Fig. 4). Cumulative quadrennial deaths from HDx were 18 by the end of 2005; 35 (a 94.4% increase) by the end of 2009; 40 (a 122.2% increase) by the end of 2013 and 49 (a 172.2% increase) by the end of 2017. There were 72 (1.6%) admitted cases of ACS during the period under review, with a mean age of 54.7 ± 12.9 years and a predominance of 42 (58.3%) males (Table 3). Females were relatively older (57.6 ± 11.4 vs 52.8 ± 11.6 years, p = 0.12). The majority (62.5%) of the patients were between the ages of 30 and 60 years. The median length of hospital stay was 12 (7.0–16.0) days (Table 3) and was comparable in males and females, namely 12.7 (7.1–19.3) vs 12.2 (8.2–18.3) days, respectively (p = 0.76). The mortality rate was comparable in males and females [three (42.9%) vs four (57.1%), respectively (p = 0.40)]. ACS admissions rose from five by the end of 2005 to 15 (200% increase) by the end of 2009; 45 (800% increase) by the end of 2013; and 72 (1 340% increase) by the end of 2017 (Table 5, Fig. 4). There were no deaths between 2002 and 2005; two deaths by the end of 2009; and four and three deaths by the end of 2013 and 2017, respectively (Table 5). The seven-day mortality rate for stroke and heart failure was 66.7 and 34.8%, respectively, while for HDx and ACS it was 16.4 and 14.1%, respectively. Fig. 5 shows the Kaplan–Meier curves for the CVD cases. Stroke had the lowest survival rate and shortest length of hospital stay among the four major CVD admissions sub-types, followed by heart failure. This trend persisted even after censorship of the data. ACS had the best survival estimate, although in absolute numbers it had the lowest admission rates. Discussion This research, to the best of our knowledge, is the largest hospital-based study in sub-Saharan Africa (SSA) that has studied the trends in CVD admissions and deaths. CVD cases are said to constitute about seven to 10% of all adult medical admissions in SSA.14,15 Our study found a CVD admission rate of 20.8% over a 16-year period. In Nigeria, CVD admission rates vary between 15 and 43.7%.16,22-24 A recent 10-year review of medical admissions in Ghana reported a 4.7% CVD admission frequency, with stroke admissions excluded as an outcome of interest.25 If stroke admissions are excised from our data, CVD admission rate would be 11.4%, which is still higher than the 4.7% from the Ghanaian study but comparable to the SSA range. Our study duration of 16 years possibly accounts for this difference. Our Table 6. Patterns of heart failure admissions and outcomes (2002–2017) Heart failure n (%) Gender p- value* Age, median (IQR) Gender p- value** LOHS, median (IOR) p- value*** Outcomes p- value* Male, n (%) Female, n (%) Male median (IQR) Female median (IQR) Discharge n (%) DAMA n (%) Death n (%) HF admissions 1 606 (36.2) 762 (47.4) 844 (52.6) 53 (40–66) 55 (43–67) 52 (37–65) < 0.001 13.0 (7.0–22.0) 1 366 (84.9) 29 (1.2) 224 (13.9) HF aetiology 0.88 HHDx 789 (49.1) 371 (47.0) 418 (53.0) < 0.001 54 (41–67) 53 (44–67) 55 (40–67) 0.76 12.0 (6.0–20) 672 (85.2) 15 (1.9) 102 (12.9) 0.48 DCM 594 (37.0) 316 (53.2) 278 (46.8) 53 (40–65) 55 (42–65) 51 (37–65) 0.04 12.0 (7.0–23) 508 (85.5) 2 (0.3) 84 (14.1) PPCM 66 (4.1) – 66 (100) 32 (29–37) NA 32 (28–37) NA 14.0 (4.0–26.0) 54 (81.8) 1 (1.5) 11 (16.7) Anaemia 25 (1.6) 9 (36.0) 16 (64.0) 42 (31–52) 60 (48–76) 42 (30–49) 0.050 15.0 (4.0–38.0) 22 (88.0) 0 (0.0) 3 (12) CKD 17 (1.1) 10 (58.8) 7 (41.2) 43 (39–45) 44 (40–45) 39 (32–48) 0.178 15 (7.0–23.0) 15 (88.2) 0 (0.0) 2 (11.8) Valvular Dx 13 (0.8) 5 (38.5) 8 (61.5) 70 (37–71) 71 (71–72) 38 (36–64) 0.632 20.0 (9.0–24.0) 10 (76.9) 0 (0.0) 3 (23.1) Others 102 (6.4) 51 (50.0) 51 (50.0) 60 (49–74) 64 (49–75) 57 (49–72) 0.311 10.0 (5.0–21.0) 82 (80.4) 1 (1.0) 19 (18.6) *Chi-squared test; **analysis of variance; ***Kruskal–Wallis. HF, heart failure; HDx, hypertensive heart disease; DCM, dilated cardiomyopathy; PPCM, peripartal cardiomyopathy; CKD, chronic kidney disease; Dx, disease; LOHS, length of hospital stay; DAMA, discharged against medical advice. Length of stay (days) 0 100 200 300 400 Cumulative survival 1.0 0.8 0.6 0.4 0.2 0.0 Long rank p-value < 0.001* Heart failure Heart failure-censored Acute coronary syndrome Acute coronary syndrome-censored Stroke Stroke-censored HDx HDx-censored Fig. 5. Kaplan–Meier curves of time to mortality in CVD types. HDx, hypertensive diseases.
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