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 Table of Contents  
ORIGINAL ARTICLE
Year : 2013  |  Volume : 10  |  Issue : 1  |  Page : 14-17

Cardiac emergencies in a Nigerian hospital: Data from the Abeokuta heart disease registry


1 Department of Medicine, University College Hospital, PMB 5116 Ibadan, Oyo, Nigeria
2 Federal Medical Centre, Idi-Aba, Abeokuta, PMB 3031 Sapon Abeokuta, Ogun, Nigeria
3 Department of Chemical Pathology, University College Hospital, PMB 5116 Ibadan, Oyo, Nigeria

Date of Web Publication21-Sep-2013

Correspondence Address:
Okechukwu S Ogah
Department of Medicine, Division of Cardiology, University College Hospital, Ibadan PMB 5116, Ibadan, Oyo
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0189-7969.118573

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  Abstract 

Background: The emergency room is most often the gateway to many hospitals and health facilities. The spectrum of medical disease (including cardiac disease) in this department is often a reflection of the pattern of diseases in the immediate environment.
Objective: The aim of this study therefore is to describe the spectrum of cardiac diseases presenting at the emergency room of Federal Medical Centre, Abeokuta, Ogun State, Nigeria.
Methods: This was a retrospective analysis of a prospectively acquired data over a period of 24 months (January 2006 to December 2007) and was conducted at the Emergency Department of the Federal Medical Centre, Abeokuta, Nigeria. All cardiac cases presenting to the centre during the period of the study were consecutively captured using structured and uniform case report form. Data collected include the patient's bio data, data of admission as well as clinical diagnosis. Disease classifications were based on International Classification of Disease-10.
Results: A total of 414 patients classified as cardiac presented to the medical emergency room between January 2006 and December 2007. This constituted 17.4% of all medical cases seen at this department during this period. There were 208 men (50.2%) and 206 women (49.8%). The mean age of all the subjects was 54.7±14.6 (range 15-90 years). Majority of the patients (48.5%) were between the ages of 40 years and 59 years. The most common reasons for cardiac related admissions include severe hypertension, acute heart failure or acute left ventricular heart failure.
Conclusions: Cardiac related admissions in the emergency room in Abeokuta are related to hypertension and its complication-heart failure. Prevention as well as management of cardiac diseases should be tailored to hypertension and its associated risk factors. Facilities for management of hypertension and heart failure should be provided in our emergency room.

Keywords: Abeokuta, cardiac emergencies, emergency room, Nigeria


How to cite this article:
Ogah OS, Akinyemi RO, Ogbodo EI, Ogah FA. Cardiac emergencies in a Nigerian hospital: Data from the Abeokuta heart disease registry. Nig J Cardiol 2013;10:14-7

How to cite this URL:
Ogah OS, Akinyemi RO, Ogbodo EI, Ogah FA. Cardiac emergencies in a Nigerian hospital: Data from the Abeokuta heart disease registry. Nig J Cardiol [serial online] 2013 [cited 2019 Mar 20];10:14-7. Available from: http://www.nigjcardiol.org/text.asp?2013/10/1/14/118573


  Introduction Top


The emergency room is often the entry point to many hospitals and health-care facilities. Hence, the spectrum of disease conditions including cardiac diseases in this department reflect the pattern of disease in the immediate environment or catchment area.

Knowledge of pattern of diseases in any particular health facility is therefore, very important in the planning as well as provision of health services.

There is limited data on pattern of cardiac conditions presenting at the emergency room in the country.

The main aim of this paper is therefore, to determine as well as describe the pattern of cardiac emergencies at the Federal Medical Centre, Abeokuta, Nigeria.


  Materials and Methods Top


The study was conducted at the Emergency Department of the Federal Medical Centre, Abeokuta, Nigeria from January 2006 to December 2007.

The centre is a tertiary institution, which serves the people of Ogun State as well as neighboring environments in the South Western part of the country.

It was established in 1993 by the Federal Government of Nigeria. The State has a population of about 3.2 million and a land area of about 16,409.26 sq km.

All cardiac cases presenting to the centre during the period of the study were consecutively captured using a structured and uniform case report form.

All the diagnoses were based on the input made by the supervising cardiologist.

Information obtained includes patient's age, gender, and date of admission as well as clinical diagnoses.

Disease classifications were based on International Classification of Disease-10.

Ethics approval was obtained from the Institution's Ethics Review Committee.

Data management and statistical analysis

All the data obtained were entered into SPSS 15.0 (SPSS Inc. Chicago, IL USA). This package was also employed in the statistical analysis.

Descriptive statistics was used in the summary of the data. Where applicable, a P value of <0.05 was assumed to be statistically significant.


  Results Top


[Table 1] depicts the baseline characteristics of the subjects who were 414 in number. There were 208 men (50.2%) and 206 women (49.8%).
Table 1: Clinical characteristics of the subjects

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The mean age of all the subjects was 54.7±14.6 years with a range of 15-90 years.

Most of the patients were in the 40-69 years age bracket, with those in the age group of 50-59 years having the highest representation (27.5%).

The women were older than the men. [Figure 1] shows, the age distribution of the population. Cardiac emergencies constituted about 17.4% of all medical cases seen at the emergency room during this period.
Figure 1: Histogram showing the age distribution of the 414 subjects

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[Table 2] and [Figure 2] show the pattern of cardiac diseases presenting at the emergency room of this Hospital.
Table 2: Pattern of cardiac emergencies in the study population

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Figure 2: Spectrum of cardiac emergencies in Abeokuta

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By far severe hypertension (49.5%) and congestive cardiac failure (44.9%) were the most common cardiac emergencies in the hospital constituting about 94% of the total number of cardiac cases presenting during this period of study.

Other causes of cardiac related admission in the order of decreasing frequency include: Acute chest pain (only two cases were confirmed cases of myocardial infarction), arrhythmia, cardiac tumor, constrictive pericarditis, deep vein thrombosis, heart block, and infective endocarditis. In terms of temporal trend in admission pattern, the peak periods of admission were in the months of January, May/June and November. Admission was the lowest in the month of February [Figure 3].
Figure 3: Temporal trend in emergency cardiac admission in the 414 subjects

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  Discussion Top


The main findings from this descriptive study were: Cardiac related admissions constituted about 17.4% of the total medical admission during the period of the study, women were older than the men, majority of the subjects were in the middle age bracket, the most common reasons for admission were related to hypertension and heart failure and finally, the peak period of admission was in the months of January, May/June and November.

Cardiac admissions represent a significant cause of morbidity in the medical emergency room only second to infections/communicable diseases (47.6%). It is the most common non-communicable cause of emergency admission in Abeokuta followed by Neurological admission (principally stroke).

This is similar to the findings of Odenigbo and Oguejiofor, [1] Ogun et al., [2] Ike, [3] and Unachukwu et al. [4] However, these studies were based on in-patient medical admissions.

In the study by Ike, [3] cardiac diseases constituted about 18.8% of in-patient medical admissions over a 5 year period with non-communicable diseases accounting for 60.3% of the total admission.

In the study by Ogun et al., [2] cardiovascular diseases accounted for 9.9%.

In this study, women were found to be older than the men. This is not surprising as women generally present later with chronic diseases than men due to the protective effect of the female hormone.

Unlike in developed countries of the world where cardiac diseases present mainly in the elderly population, this condition is a problem of middle age in developing and middle income countries. Cardiac diseases; therefore, affect the economic productive age group of our population leading to high Disability-adjusted life years. [5]

The study also revealed that hypertension and heart failure are the significant causes of cardiac emergency in Abeokuta, Nigeria. Over 65% of the heart failure cases are related to high blood pressure. This therefore, confirms the observation that hypertension is the foundation of heart disease in Sub-Saharan Africa. [6]

Effective control of high blood pressure will significantly affect the burden of cardiac related admission in the population.

We also noted a temporal trend in pattern of cardiac admission in Abeokuta in which more admissions were recorded in the wet seasons of the year although the month of December recorded low admission rate. This pattern has been reported by previous workers with respect to chronic diseases. [3],[7],[8],[9]


  Conclusions Top


Cardiac disease admissions in Abeokuta, Nigeria are related to hypertension and its complication heart failure. Prevention in addition to effective management of cardiac diseases should be tailored to hypertension and its associated risk factors.

More so facilities for the management of hypertension and heart failure should be provided in the emergency rooms.

Regular training as well as adherence to guidelines on the management of severe hypertension should be encouraged in our hospitals.

Finally, because of the observed temporal trend in the admission of cardiac and other related non-communicable diseases in the country, high admissions can be anticipated at some periods of the year and resources mobilized, accordingly to meet the expected increase in demand during these periods.

 
  References Top

1.Odenigbo CU, Oguejiofor OC. Pattern of medical admissions at the Federal Medical Centre, Asaba-a two year review. Niger J Clin Pract 2009;12:395-7.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Ogun SA, Adelowo OO, Familoni OB, Jaiyesimi AE, Fakoya EA. Pattern and outcome of medical admissions at the Ogun State University Teaching Hospital, Sagamu-a three year review. West Afr J Med 2000;19:304-8.  Back to cited text no. 2
[PUBMED]    
3.Ike SO. The pattern of admissions into the medical wards of the University of Nigeria Teaching Hospital, Enugu (2). Niger J Clin Pract 2008;11:185-92.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.Unachukwu CN, Agomuoh DI, Alasia DD. Pattern of non-communicable diseases among medical admissions in Port Harcourt, Nigeria. Niger J Clin Pract 2008;11:14-7.  Back to cited text no. 4
[PUBMED]    
5.Sanderson JE, Mayosi B, Yusuf S, Reddy S, Hu S, Chen Z, et al. Global burden of cardiovascular disease. Heart 2007;93:1175.  Back to cited text no. 5
    
6.Cooper RS, Amoah AG, Mensah GA. High blood pressure: The foundation for epidemic cardiovascular disease in African populations. Ethn Dis 2003;13:S48-52.  Back to cited text no. 6
[PUBMED]    
7.Ansa VO, Ekott JU, Essien IO, Bassey EO. Seasonal variation in admission for heart failure, hypertension and stroke in Uyo, South-Eastern Nigeria. Ann Afr Med 2008;7:62-6.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.Isezuo SA. Seasonal variation in hospitalisation for hypertension-related morbidities in Sokoto, north-western Nigeria. Int J Circumpolar Health 2003;62:397-409.  Back to cited text no. 8
[PUBMED]    
9.Kadiri S, Arije A. Temporal variations and meteorological factors in hospital admissions of chronic renal failure in south west Nigeria. West Afr J Med 1999;18:49-51.  Back to cited text no. 9
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2]



 

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