Multimorbidity and predictors of mortality among patients with cardiovascular disorders admitted to an intensive care unit: a retrospective study

AbstractBackground: Prevalence of cardiovascular risk factors is reported to be increasing in Ethiopia. Multimorbidity of these risk factors is more likely to lead cardiovascular disease (CVD) with increased hospital admission, premature death, and poor quality of life and increase health care expenditure. There is little evidence regarding magnitude and outcome of CVD multimorbidity, particularly in the African setting. The aim of this study was to examine the magnitude of multimorbidity and predictors of mortality in patients with cardiovascular disease admitted to the Medical Intensive Care Unit of St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia.Methods: A five-year retrospective study was conducted from 01 November 2015 to 01 January 2016. A total of 362 patients with cardiovascular disease who were admitted to the Medical Intensive Care Unit participated in the study. The primary endpoint was death from any cause in the Medical Intensive Care Unit while the secondary was a cardiovascular composite. For baseline characteristics and survival analysis we classified patients according to their level of multimorbidity. We used Cox proportional hazards models to evaluate the prognostic effect of the level of risk factors or multimorbidity at admission while controlling for confounding variables.Results: A total of 71 (19.6%) patients had a diagnosis of multimorbidity. The most common cases of cardiovascular admission were heart failure, 137 (37.8%), acute myocardial infarction, 83 (22.9%), hemorrhagic stroke, 95 (26.2%) and ischemic stroke, 24 (6.6%).There were 162 (45%) deaths. Myocardial infarction (COR 0.3; 0.18-0.53), hemorrhagic stroke (COR 3.3; 2.0-5.5) and age groups 55-64 years (COR 2.7; 1.2-6.1) and 65-74 years (COR 2.6; 1.1-6.1) were significantly associated with mortality.Conclusions: There is a significant proportion of multimorbidity in our study population. Multimorbidity may be used as a criterion to prioritize and improve the management of patients. Measures to prevent cardiovascular disease in people who already have hypertension, diabetes or underlying causes of heart failure in primary care settings need to be emphasized. At higher levels of care, capacity building is key to addressing the management of patients who present with acute cardiovascular diseases.  [Ethiop. J. Health Dev. 2018;32(4):218-224]Keywords: Cardiovascular disease, multimorbidity, mortality, intensive car

Medical Admissions and Outcomes at Saint Paul’s Hospital, Addis Ababa, Ethiopia: a retrospective study

Background: Globally, trends of medical admission have been changing. This study was carried out to assess the current trend of medical admissions and outcomes in Ethiopia.Methods: Retrospective review of 840 records of patients admitted to medical ward of Saint Paul hospital during April 1, 2012-March 31, 2013 was done. Ethical approval was obtained from the IRB of the hospital. Data on demographic profiles, reasons for admission, final diagnosis, length of hospital stay and treatment outcomes were recorded by physicians on structured format developed for this purpose. The data were entered & analysed using SPSS software version 20.Results: Most of the patients were from Addis Ababa. The mean age of patients was 40.9±17.7 years, 470 (56%) of the patients were females and 71% were married. Non-communicable diseases (NCDs) contributed to 51.1% of admissions. Communicable diseases were dominant diagnosis for those groups in 35-44 years of age while noncommunicable diseases were dominant diagnosis for those 45-54 years of age and above. The three most common reasons for immediate admission to the hospital were pneumonia 188 (22.4%), tuberculosis 177 (21.1%) and heart failure 134 (16.0%). And the major diagnoses for underlying illnesses during admissions were found to be AIDS 177 (21.1%), hypertension 102 (12.1%), diabetes mellitus 102 (12.1%), atherosclerotic cardio vascular disorders 86 (10.2%), gastrointestinal disorders 56 (6.7%), valvular heart diseases 51 (6.1%), and renal failure 46 (5.5%). Mean duration of stay in medical wards was 12.3 (+/-10) days and it is comparable for communicable diseases and non-communicable diseases. Two third of the medical admissions (66.4%) were discharged improved while mortality was close to one fourth (24.2%). Communicable diseases contributed to two thirds of the mortality (15.6%).Conclusion: Non-communicable diseases were the major cause of admission to the hospital while communicable diseases contributed to two thirds of the overall mortality predominantly among the younger patients. Health professionals, policy-makers and health planners should recognize the higher morbidity and hospital burden from non-communicable diseases and the higher mortality from communicable diseases. Key words: Medical admission, communicable and non-communicable, morbidity, mortality, Ethiopi

Assessment of inhaled corticosteroids use and associated factors among asthmatic patients attending Tikur Anbessa Specialized Hospital, Ethiopia

Abstract Background Inhaled corticosteroids (ICSs) are cornerstone therapy for persistent asthma. However, underutilization of ICSs is common and little is known about factors contributing toward this undesirable use. Methods A cross-sectional study was conducted through interview and chart review among persistent asthmatic patients attending chest clinic of Tikur Anbessa Specialized Hospital from 1 May to 31 September 2014. A total of 131 eligible patients who attended the clinic during study period were included in the study. A multivariate logistic regression was used to examine the association between independent and dependent variables. Results Overall, extent of underutilization of ICSs was found to be 68%. Monthly income, comorbidity and types of ICSs products prescribed showed significant association with reported underutilization. Patients’ reported reasons for underutilization includes; unaffordability (44%), using only when symptoms exacerbate (21%), fear of side effects (10%), practitioners’ recommendation (10%) and unavailability of ICSs in the local market (7%). Physicians also stated unaffordability, fear of side effects and dependency, lack of local guideline for asthma management and unavailability of ICSs as the contributing factors. Conclusion In this setting, extent of underutilization of ICSs was found to be high and seems the result of complex interaction of various factors. Financial problem combined with inconsistent availability of ICSs in the local market, patients’ poor knowledge of asthma and ICSs, negative attitude toward ICSs, absence of local guidelines for asthma management are found to be essential elements dictating an extent of ICSs use