Trends in cardiology admissions and mortality across 37 hospitalization departments in Sub-Saharan Africa: The FEBRUARY study (2016-2023)

Abstract

Abstract Background Cardiovascular disease is a leading cause of mortality worldwide. At least two-third of CVD death occurs in low- (LIC) and middle-income(MIC) countries. Recent studies estimate that CVD are responsible for 13% of all deaths in Sub-Saharan Africa(SSA). Scarce data are available about the admission to hospital for CVD and outcome in cardiology department in SSA. Purpose To describe causes of admission for CVD and outcome of hospitalization in 17 in SSA countries. Methods We conducted a transversal and longitudinal study in CV department of 37 hospitals from 23 cities in 17 SSA countries (10 low income: Niger, Guinea, Benin, Mali, Democratic Republic of the Congo, Tchad, Burkina Faso, Togo, Burundi, Ethiopia and 7 middle income: Cote d’Ivoire, Senegal, Cameroon, Congo, Soudan, Mauritania, Gabon). The February study was designed by a multidisciplinary collaborative team of epidemiologists, pharmacists and cardiologists from Africa and France. This ongoing observatory included all inpatients in February from each year since 2016. Data including socio-demographic and clinical characteristics, causes of admission, clinical, biological, complementary examinations, treatments, length of stay and discharge diagnosis were collected by the investigating physicians. All analyses were performed through scripts developed in the R software (4.0.3(2020-10-10)) Results Overall, 4945 patients were included over the 8 years of the study. Men represented 56.1%. Mean of age was 56.6 ± 16.9 years. The main cause of admission was heart failure (42%) followed by acute coronary syndrome (12%) and stroke (11%). Cause of admission varied significantly across countries (p<0.01) and over the years (p<0.01). Proportions of admission for heart failure varied from 28% in Democratic Republic of the Congo to 75% in Guinea. Mean of length of stay was 9.8±22days. All causes of admission confounded, in-hospital mortality rate was 11% (N=471). Hospital mortality rate differed significantly according to causes of admission (p<0.01).Mortality rate among patients admitted for stroke, heart failure and acute coronary syndrome was respectively 18.5%, 12.2% and 8.8%. Overall, 32 (0.7%) were admitted for endocarditis and mortality rate among them was 20.8% (figure). Overall, mortality rate did not vary according to gender or level-income countries but was significantly different over the years; according to countries (p<0.01) and to patient wealth index (p<0.05). Mortality rate was significantly higher in patient with low wealth index. Conclusion Our study describes the causes of admission and the associated in-hospital mortality rate over an eight-year period in 17 sub-Saharan African (SSA) countries. We identified several disparities related to the causes of admission and income levels. Inequities in access to care remain a barrier to reducing the burden of cardiovascular disease (CVD) in Africa.