TRENDS IN CARDIOVASCULAR DISEASE OVER TIME: A 30-YEAR RETROSPECTIVE ANALYSIS OF MEDICAL-ICU ADMISSIONS IN ADDIS ABABA, ETHIOPIA.

BACKGROUND: Increased urbanization with change in lifestyle in many developing countries exposed them to the challenge of double disease burden, battling with the existing communicable infectious diseases as well as the emerging epidemic of NCDs. OBJECTIVE: To describe trends of medical intensive care unit admission over thirty years in Ethiopia. METHODS: MICU registries at Tikur Anbessa Specialized Hospital over a thirty year period were examined for discharge diagnosis. Data included for analysis were selected at ten-year interval of equivalent six- months' period from December to May of 1981/82, 1991/92, 2001/02 and 2011/12. Variables included were age, gender, residence, discharge diagnosis, duration of stay in hospital, discharge status, admission date, and admission source. Obtained data were cleaned, coded, recoded and edited. The analysis was done using SPSS 15.0 statistical soft ware. RESULTS: A total of 500 cases are included for analysis. Among these 284 (57%) were male. The mean age was 40.2 ± 18 years rangingfrom 13 to 87 years. The aggregate cardiovascular disease, other non communicable disease and infectious disease as a cause of admission in the past thirty years were 213 (42.6), 141 (22.8), 105 (20.0) respectively. Unlike the other disease category cardiovascular disease increased steeply over the past thirty years. Overall case fatality rate at MICU was 31.6% ranging from 24.8% of other-NCD to 46.7% of infectious diseases. CONCLUSION: Cardiovascular disease has steeply increased till it became predominant in the last decade at MICU of TASH.

Characteristics and management of patients with acute coronary syndrome at Tikur Anbessa Specialized Hospital, Addis Ababab, Ethiopia.

BACKGROUND: Evidence based clinical guidelines have provided clinicians with an increasing tool for management of hospitalized patients. However, large differences in the management of patients with acute coronary syndrome observed across the globe. OBJECTIVE: To determine spectrum of severity, practice patterns and half-year outcomes of patients hospitalized with acute coronary syndrome in Ethiopia. METHODS: All charts from patients admitted to the intensive care unit of Tikur Anbessa Specialized Hospital over a six months period in 2011/12 were examined for discharge diagnosis of acute coronary syndrome. Complete data for these patients was collected for analysis. A total of 21 cases with complete data were included for analysis. RESULTS: Among a total of 21 patients, 16 (65.2%) were males. The mean age was 57.1 +/- 13.7 ranging from 33 to 80 years. All those patients had cardiac biomarkers and electrocardiography (ECG), 14 (66.7%) had echocardiography and only 2 (9.6%) patients had coronary angiography. Based on diagnostic result 13 (62%) patients had ST-elevation myocardial infarction (STEMI), 6 (28.6%) had non-ST elevation myocardial elevation (NSTEM) 1 and 2 (9.5%) had unstable angina. All were given anti-platelets and statin but none of them got thrombolytics. Three (14.4%) patients died after two weeks of hospitalization. CONCLUSION: Unavailability of reperfusion therapy with high rate of mortality and less diagnosis of non ST-elevation acute coronary syndrome were seen. Implementation of evidence-based medications and interventions, including reperfusion therapy is needed.