Predominance of Hypertension - Related morbidity and mortality at the cardiac intensive care unit, douala general hospital, Cameroon

Abstract

Objective: Hypertension is the main driver of the cardiovascular disease epidemic in Africa. It is suggested that hypertension - related mortality eclipses that of HIV/AIDS and malaria, though this is underappreciated. This study aimed at investigating the morbidity and mortality of patients admitted for cardiovascular emergencies at the Cardiac Intensive Care Unit (ICU) of the Douala General Hospital, Cameroon.

Design and method: This was a retrospective cohort study. All patients aged ≥18years and hospitalized for cardiovascular emergencies between October 2012 and December 2014 were included. Data on socio-demographic, clinical profiles and intra-hospital outcomes were collected. Kaplan Meier estimator and logistic regression models were used to relate baseline characteristics to mortality during admission.

Results: Of 333 patients hospitalized for cardiovascular emergencies (overall mean age was 62 ± 13.8 years, 53.2% were men), 75.1% (250/333) were hypertensive. The main presenting features were at least one focal neurologic deficit (42.6%) and dyspnea (41.1%). Stroke – (42.1%; 24.6% ischaemic, 17.7% haemorrhagic) and hypertensive heart failure (25.2%) were the most prevalent emergencies. In-hospital mortality was 31.8%, of which 50% were secondary to stroke (32.1% haemorrhagic, 18.9% ischaemic) and 20.8% due to acute heart failure. The main predictors of in-hospital mortality include Glasgow score <7 [aOR; 1.78, 95% confidence interval (CI); 1.41–2.24], prolonged hospital stay [aOR; 1.23, 95% CI; 1.09–1.36] with the occurrence of cardiovascular [aOR; 0.95, 95% CI 0.93–0.98] and infectious [aOR; 0.38, 95% CI; 0.18–0.79] complications.

Conclusions: About three-quarters of patients were hypertensive with 1 in 3 of the overall cohort dying during admission. Stroke and acute heart failure were the most prevalent and lethal cardiovascular emergencies. This high in-hospital mortality reflects the need for definition and implementation of timely and appropriate strategies to address the growing burden of cardiovascular diseases especially hypertension in our setting.