Quality of management of acute coronary syndrome at the Nouakchott National Heart Center (Mauritania).

INTRODUCTION: Acute Coronary Syndrome (ACS) is a diagnostic and therapeutic emergency whose management is standardized by multiple learned societies. AIM: To describe the quality of the management of the SCA at the National Heart Center (CNC) in Nouakchott, Mauritania. METHODS: This is a cross-sectional study of patients admitted to SCA at the Nouakchott CNC between July 31 and December 16, 2017. RESULTS: A total of 80 patients, were enrolled in this study (hospital prevalence: 10.6%). Males were predominant (sex ratio: 2.3) and mean age was 62.5±10.6. Only one fourth of patients had health insurance coverage. Medical transportation by ambulance were provided only for 29% of patients. Typical chest pain was the most frequent reason for consultation (83.8% of cases) and the average admission time was 34.83±11.87 hours. Almost two thirds of patients (68%) had an ST segment-elevation myocardial infarction. Of those patients, only 23 were managed within-12 hours of chest pain onset; reperfusion treatment was attempted by primary Percutaneous Coronary Intervention (PCI) in only one case and thrombolysis in 22 (28%) others and was success in 81% of cases. All ACS-patients received antithrombotic drugs as recommended by the local protocol and 55 (69%) patients underwent a coronary angiography that revealed 58.2% mono-truncular, 18.2% bi-truncular and 14.5% tri-truncular lesions, supporting the indication for PCI in 31 patients, Coronary artery bypass graft in 6 patients and medical therapy in the remaining patients. During the hospital course, complications were observed in 22.5% patients with a total mortality of 3.8%. CONCLUSION: Management of ACS at the Mauritanian CNC could be optimized by the implementation of a pre-hospital care chain based on easy access to first-line facilities, efficient transportation system and early coronary revascularization.

Epidemiological, clinical and progressive aspects of arterial hypertension in older patients in Nouakchott (Mauritania).

OBJECTIVE: To describe the epidemiological and clinical profile of hypertensives aged 60 years and over followed outpatient, at the National Heart Center of Nouakchott (CNC) in Mauritania. METHOD: This is a descriptive, cross-sectional study conducted from February to July 2016, including elderly hypertensive patients, followed on an outpatient basis at the CNC. RESULTS: We had 150 patients representing 12.6% of the CNC's consultants, 101 of whom were included in the study. The mean age was 67.3 ± 5.78, and the sex ratio was 1.02. Systol-diastolic hypertension was predominant (69.3%). Three main cardiovascular risk factors were more frequently associated: sedentary lifestyle (59%), obesity or overweight (58%) and hypercholesterolemia (52%). The average number of cumulative risk factors was 3.4. Overall cardiovascular risk was high in 70.3% of patients. The symptomatology was dominated by headache (51.4%). Cardiac involvement was the most common complication (49%) with a predominance of left ventricular hypertrophy (18.8%). Renal involvement and stroke (exclusively ischemic) were reported in 24.8% and 12.9% of cases, respectively. Therapeutically, the most frequently used molecules were calcium channel blockers in monotherapy and the combination of calcium channel blockers and the conversion enzyme, in dual therapy. CONCLUSION: In Mauritania, the elderly hypertensive patient presented multiple cardiovascular risk factors and cardiac complications. The decentralization of its care to the front-line health structures would be essential for a more rational management of the arterial hypertension of the elderly subject.