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ObjectiveTo evaluate the impact of the COVID-19 pandemic on the delivery of cardiology services in Africa. DesignCross-sectional e-survey study. SettingAfrican countries ParticipantsCardiologists Primary and Secondary outcomes measuresThe primary outcome was the change in service delivery in African cardiology units during the on-going COVID-19 pandemic. The secondary outcomes were the satisfaction of cardiologists with regards to the workload and factors associated with this satisfaction. ResultsThere was a significant reduction in working time and the number of patients consulted by week during this pandemic (p<0.001). In general, there was a decrease in the overall activities in cardiovascular care delivery. The majority of cardiology services (76.5%) and consulting programs (85%) were adjusted to the pandemic. Only half of the participants were satisfied with their workload. Reconfiguration of the consultation schedule was associated with a reduced satisfaction of participants (p=0.02). ConclusionsCOVID-19 is associated with an overall reduction in cardiology services rendered in Africa. Since the cardiovascular burdens continue to increase in this part of the World and the risk of cardiovascular complications linked to SARS COV2 remains unchanged cardiology, departments in Africa should anticipate a significant surge of cardiology services demanded by patients after the COVID-19 pandemic. Strengths and limitations of this studyO_LIThe study is one of the first African studies to report the impact of the COVID-19 pandemic on the delivery of cardiology services which are very important for Africans given the high prevalence of cardiovascular diseases in this continent. C_LIO_LIThe multinational design of the study leading to the inclusion of 14 African countries makes the results generalizable to the entire African. C_LIO_LIThe cross-sectional design of the study represents a major limitation as it remains impossible to either infer causality or untangle bi-directional relationships between the reduction of the delivery in cardiology services and the pandemic or participants satisfaction. C_LIO_LIAlso, the e-survey was drawn in English and this might have restricted the participation by some non-English African respondents due to the language barrier. Hence, perhaps contributing to the relatively small sample size of the study. C_LI
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BACKGROUND: Estimates from developed countries show that early mortality after stroke is unaffected by diabetes status. Despite the high burden of both conditions in sub-Saharan Africa, data on the association between diabetes status and early mortality are lacking. OBJECTIVE: In a major referral hospital in the Capital city of Cameroon, among acute stroke patients diagnosed using the World Health Organization criteria, we compared mortality rates in patents with and without known diabetes. METHODS: Stroke patients with and without known diabetes were compared for demographic characteristics, risk factors, clinical, radiological, laboratory characteristic, and in-hospital mortality. Heterogeneities in mortality rates across major subgroups were investigated via interaction tests, and logistic regression accelerated failure-time models used to adjust for confounders. RESULTS: Of the 1667 acute stroke patients included, 213 (12.8%) had diabetes mellitus. In general diabetic patients were older (median age 64.0 vs. 62.0 years, p=0.0006), and were more likely to have other stroke risk factors including a higher triglyceride levels on admission (106 vs. 97mg/dL, p=0.044), a history of stroke (19.7% vs. 13.6%, p=0.022), and a history of hypertension (89.7% vs. 64.8%, p<0.0001). The death rates of diabetic patients and that of non-diabetic patients were similar (22.1% vs. 20.1%. p=0.524). This finding was similar across all pre-specified groups, with no evidence of interaction. Diabetes was unrelated with mortality in adjusted regression models. CONCLUSION: Diabetes is frequent among stroke patients in this setting, and often co-exists with other stroke risk factors. In-hospital mortality rate is equally high in diabetic and non-diabetic patients.
