|Year : 2013 | Volume
| Issue : 2 | Page : 77-80
Pattern of cardiovascular disease amongst medical admissions in a regional teaching hospital in Southeastern Nigeria
Nelson I Oguanobi, Emmanuel C Ejim, Basden JC. Onwubere, Samuel O Ike, Benedict C Anisiuba, Vincent O Ikeh, Emmanuel O Aneke
Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
|Date of Web Publication||13-Feb-2014|
Nelson I Oguanobi
Department of Medicine, University of Nigeria Teaching Hospital, Enugu
Source of Support: None, Conflict of Interest: None
Background: Cardiovascular disease (CVD) is responsible for a large proportion of death and disability worldwide. However, a substantial portion of the increasing global impact of CVD is attributable to economic, social, and cultural changes that have led to increases in risk factors for CVD. These changes are most pronounced in the countries comprising the developing world. Because the majority of the world's population lives in the developing world, the increasing rate of CVD in these countries is the driving force behind the continuing dramatic worldwide increase in CVD.
Objective: This study was aimed at determining the frequency and pattern of cardiovascular disorders in the medical wards as well as the emergency and intensive care units of the University of Nigeria Teaching Hospital (UNTH) Enugu, Southeast Nigeria.
Methods: A retrospective study of consecutive adult patients with diagnosis of cardiovascular disorders admitted into the medical wards and/or the emergency/intensive care units of UNTH Enugu between January 2000 and January 2007 was carried out using the ward admission and discharge registers.
Results: A total of 6,162 patients (males 3,385 (54.93%); female 2,777 (45.07%)) were admitted over the period covered by the study. Out of these; 1,261 (20.46%) patients were found to have cardiovascular disorder. Prevalence of cardiovascular disorders was found to be higher among the female patients than among the males: 693 (24.95%) and 568 (16.78%) years, respectively. The ages ranged between 18 and 92 years with a mean ± standard deviation (SD) of 55.13 ± 15.37. The pattern of CVD observed in this study were hypertension and its complications (86.36%), rheumatic heart disease (4.52%), dilated cardiomyopathy (3.09%), and alcoholic heart muscle disease (0.95%).
Conclusion: CVDs were major causes of morbidity in the environment of study. Early detection, improved outpatient care, as well as inclusion of appropriate secondary prevention programs in patient's management especially at the community level is recommended in order to reduce complications and the need for hospital admissions.
Keywords: Admissions, cardiovascular disease, Nigeria, pattern
|How to cite this article:|
Oguanobi NI, Ejim EC, Onwubere BJ, Ike SO, Anisiuba BC, Ikeh VO, Aneke EO. Pattern of cardiovascular disease amongst medical admissions in a regional teaching hospital in Southeastern Nigeria. Nig J Cardiol 2013;10:77-80
|How to cite this URL:|
Oguanobi NI, Ejim EC, Onwubere BJ, Ike SO, Anisiuba BC, Ikeh VO, Aneke EO. Pattern of cardiovascular disease amongst medical admissions in a regional teaching hospital in Southeastern Nigeria. Nig J Cardiol [serial online] 2013 [cited 2019 Jan 24];10:77-80. Available from: http://www.nigjcardiol.org/text.asp?2013/10/2/77/127005
| Introduction|| |
In recent years there has been increasing concern about the burden of cardiovascular disease (CVD) in developing countries. , For much of the 20 th century, the majority of CVD occurred in industrialized developed countries. However, over the past few decades, the absolute burden of CVD has been greater in developing countries. , Reports from the Global Burden of Disease Study 2010 revealed that noncommunicable diseases accounted for 66.7% of death worldwide, with CVD contributing 43% to the global mortality figure. The total global burden of CVD in terms of disability-adjusted life years (DALYs) stood at 15% in 2010. ,, In developed countries, despite the overall increase in CVD burden, age-adjusted death rates for most causes of CVD are declining largely due to effective preventive and therapeutic interventions. It is estimated that in 1990 there were already almost twice as many death and more than three times as many DALYs attributable to CVDs in developing countries than there were in developed countries. By 2020 it is estimated that there will be about 6 million deaths and 35 million DALYs annually from cardiovascular causes in developed countries and about 19 million deaths and 170 million DALYs annually from cardiovascular causes in developing countries.  The increase in CVD burden in developing countries is largely the result of an increase in the prevalence of risk factors due to the combined effects of industrialization, rural-urban population drift, urbanization, and associated effects on the levels of cardiovascular risk factors as well as the relative lack of access to the modern medical interventions measures. ,,, The significant positive move in combating malnutrition and infections has led to rising life expectancies in populations not afflicted with human immunodeficiency virus. ,
This study was aimed at determining the frequency and pattern of cardiovascular disorders in the medical wards as well as the emergency and intensive care units of the University of Nigeria Teaching Hospital (UNTH) Enugu, southeast Nigeria and to compare with previous studies in the institution.
| Materials and Methods|| |
A retrospective study of consecutive adult patients with diagnosis of cardiovascular disorders admitted into the medical wards and/or the emergency/intensive care units of UNTH Enugu between January 2000 and January 2007 was carried out using the ward admission and discharge registers. Data extracted from these registers include, age, sex, date of admission, and diagnosis. Where the diagnosis was in doubt, the case note was collected from the medical records unit to determine the diagnosis. Case identification was based on documented diagnosis of CVD as determined by the attending physicians either at the time of patients' discharge from the hospital or at death.
Data were presented as means ± standard deviation (SD) for continuous variables and as proportions for categorical variables. Comparison of continuous variables between the groups (male and female) was made with independent Student's t-test. For discrete variables distribution between groups were compared with Chi-square test and Fisher's exact test as appropriate (where an expected cell is less than 5). All statistical analyses were carried out using the Statistical Packages for Social Sciences (SPSS Inc. Chicago Illinois) software version 16.0. Statistical tests with 2-tailed probability values less than 0.05 were considered statistically significant.
| Results|| |
A total of 6,162 patients were admitted over the period covered by the study. Out of these; 3,385 (54.93%) were males, while 2,777 (45.07%) were females. Cardiovascular disorders were documented in 1,261 patients. This represents 20.46% of the total admissions. Prevalence of cardiovascular disorders was found to be significantly higher among the females than males: 693 (24.95%) and 568 (16.78%), respectively (χ2 24.387; P = 0.0029). The ages ranged between 18 and 92 years with a mean ± SD of 55.13 ± 15.37 years [Table 1]. About 60% (59.64%) of the patients were between the ages of 41 and 70 years with the females being relatively younger than the males (53.34 ± 13.71 and 56.42 ± 17.03, respectively; t-test 2.980, P = 0.0029). About 34% (34.13%) of the patients were aged between 18 and 50 years.
|Table 1: Age and sex distribution of the patients with cardiovascular diseases admitted during the study period|
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The pattern of CVD observed in this study were hypertension and its complications (86.36%), rheumatic heart disease (4.52%), dilated cardiomyopathy (3.09%), and alcoholic heart muscle disease (0.95%). A significant male preponderance for alcoholic heart muscle disease was observed [Table 2].
|Table 2: Pattern of cardiovascular diseases in the patients with gender comparison|
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The common complications seen in the hypertensive patients were congestive cardiac failure (43.34%), cerebrovascular accident (5.05%), heart block (4.32%), and encephalopathy (3.95%) [Table 3]. Hypertensive encephalopathy was significantly more common in the males than in females (P = 0.0067).
| Discussion|| |
This study demonstrated a high prevalence (20.46%) of CVDs among the medical admissions in UNTH Enugu, southeast Nigeria. Our finding is similar to the report of 20.06% from a hospital-based prevalence study in Port Harcourt, Nigeria.  Similar trend has been observed in other sub-Saharan African countries. In a meta-analysis of data on 86,307 medical admissions from 30 eligible studies conducted in 10 sub-Saharan African countries and covering a 61 year time period (1950-2010), Etyang and Scott  noted that the proportion of admissions due to cardiovascular disorders increased five-fold over the period from 3.9% of admissions in 1950-1959 to 19.9% of admissions in 2000-2010 (risk ratio (RR) 5.1, χ2 test for trend P < 0.00005). Over the same period the proportion of deaths caused by disorders of the cardiovascular system rose from 9.7% in 1950-1959 to 19.4% in 2000-2010 (RR 2.0, 95% CI 1.5-2.7, χ2 test for trend P = 0.08).
Our study population of patients with cardiovascular disorder was significantly skewed with a female preponderance and 60% of the patients were between the ages of 40 and 70 years. The age distribution observed in this study is in keeping with finding from a previous study by Onwubere and Ike in 2000 which reported that 56.5% of hypertensive patients admitted in the wards were in the 41-70 years age group. 
The observation in this study that the relatively younger age group (18-51 years) constituted a significant proportion (34.13%) of patients with cardiovascular disorder is quite alarming. Inpatient admission pattern for CVDs reflect the extent of morbidity and complications already developed in individuals patients. The occurrence of these complications at relatively younger ages as noted in this study conforms with previous projections by the World Health Organization ad Hoc Committee on Health Research relating to Future Intervention Options.  The economic implication of this observed trend is quite significant in view of the fact that this age group represents a significant portion of the nation's workforce. The impact of this can be enormous for a low income developing country like Nigeria. More aggressive intervention measures are therefore needed to reduce the morbidity and mortality from adverse events in patients with CVD.
Widespread implementation of intervention programs in the second half of the 20 th century resulted in an estimated 25-60% reduction in premature cardiovascular mortality in Western Europe, Australia, Canada, the USA, and Japan.  Incorporation of appropriate cost effective primary and secondary prevention strategy into the outpatient management of CVD patients will greatly reduce development of complications.
The relatively increased number of female patients admitted with CVDs may be related to the feminine low endurance threshold and attention seeking characteristics in response to ill health prompting better health seeking behavior when compared with the generally tough male masculine nature.  This may also explain the gender differences in occurrence of hypertension related complications.  However, some studies in developing countries have reported contrasting gender disparities in seeking healthcare. , These have been attributed to institutional and sociocultural factors that affect individual perception of health problems as well as access to and adequate utilization of healthcare facility. The Giza study in rural Egypt noted that women's perceptions about their own health were the single most important factor governing their utilization of health services. One-half of the women participating in the study had a reproductive tract infection (RTI), 56% had genital prolapse, and 63% were anemic. Yet the majority did not seek healthcare services for these conditions, and most of the women saw these conditions as normal.  It is not certain as to what extent this observation applies to our study population in southeast Nigeria as there is paucity of data on this subject. In any case, if the admission figures are taken as indices morbidity from complications of CVDs then the higher female hospital admission value observed in this study might reflect a rather low health-seeking behavior resulting in poor outpatient care.
The study identified hypertension and its sequel as the commonest form of cardiovascular disorder in adult patients, occurring in 86.36% of patients with cardiovascular disorders. This value represents 17.67% of the medical admissions. This is consistent with previous findings in Nigeria by Osuafor and Ele in Nnewi in 1998,  Lauckner et al., (1961) in Ibadan,  Odigwe and Esin (1991) in Calabar,  and Uzodike et al., (1971) in Enugu.  Recent studies from different parts of Nigeria have reported values within the range of 18-24%. ,,, Similarly, Ndjeka and Ogunbanjo  reported 19% from a rural hospital in South Africa. Hypertension is clearly recognized as a leading risk factor for coronary artery disease and stroke and its overall impact varies depending on the proportion of individuals in a country with untreated hypertension, thus underscoring the need of early detection and adequate control. 
This study was limited by a number of constraints. Firstly, there were several cases of data losses due to inadequate documentations and record keeping. Secondly, recurrent nationwide industrial unrest and workers strikes with the attendant disruptions during the study period resulted in partial or total loss of activity in the hospital over several time periods.
| Conclusion and Recommendation|| |
CVDs were major causes of morbidity in the environment of study. Early detection, improved outpatient care, as well as inclusion of appropriate secondary prevention programs in patient's management especially at the community level, is recommended in order to reduce complications and the need for hospital admissions.
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[Table 1], [Table 2], [Table 3]