Ehete Bahiru1, Tecla Temu2, Bernard Gitura3, Carey Farquhar4, Mark D Huffman5, Frederick Bukachi6. 1. Northern Pacific Global Health Research Fellowship Training Consortium, University of Washington, Seattle, WA, and Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, USA . Email: ebahiru@mednet.ucla.edu. 2. Department of Global Health, University of Washington, Seattle, WA, USA. 3. Kenyatta National Hospital, Division of Cardiology, Department of Medicine, Nairobi, Kenya. 4. Departments of Global Health, Epidemiology and Medicine, University of Washington, Seattle, WA, USA. 5. Department of Preventive Medicine, Northwestern University, Chicago, IL, USA. 6. Department of Medical Physiology, University of Nairobi, Nairobi, Kenya.
Abstract
BACKGROUND: Acute coronary syndrome (ACS) is understudied in sub-Saharan Africa despite its increasing disease burden. We sought to create an ACS registry at Kenyatta National Hospital to evaluate the presentation, management and outcomes of ACS patients. METHODS: From November 2016 to April 2017, we conducted a retrospective review of ACS cases managed at Kenyatta National Hospital between 2013 and 2016, with a primary discharge diagnosis of ACS, based on International Classification of Diseases (ICD) 10 coding (I20-I24). We compared the presentation, management and outcomes by ACS subtype using analysis of variance testing. We created multivariable logistic regression models using the Global Registry of Acute Coronary Events (GRACE) risk score to evaluate the association between clinical variables, including guideline-directed medical therapy and in-hospital outcomes. RESULTS: Among 196 ACS admissions, the majority (65%) was male, and the median age was 58 years. Most (57%) ACS admissions were for ST-segment-elevation myocardial infarction (STEMI). In-hospital dual antiplatelet (> 85%), beta-blockade (72%) and anticoagulant (72%) therapy was common. A minority (33%) of patients with STEMI was eligible for reperfusion therapy but only 5% received reperfusion. In-hospital mortality rate was 17%, and highest among individuals presenting with STEMI (21%). After multivariable adjustment, higher serum creatinine level was associated with higher odds of in-hospital death (OR = 1.84, 95% CI: 1.21 - 2.78), and STEMI and Killip class > 1 were associated with in-hospital composite of death, re-infarction, stroke, major bleeding or cardiac arrest (STEMI: OR = 8.70, 95% CI: 2.52 - 29.93; Killip > 1: OR = 10.7, 95% CI: 3.34-34.6). CONCLUSIONS: We describe the largest ACS registry at Kenyatta National Hospital to date and identify potential areas for improved ACS care related to diagnostics and management to optimise in-hospital outcomes.
BACKGROUND:Acute coronary syndrome (ACS) is understudied in sub-Saharan Africa despite its increasing disease burden. We sought to create an ACS registry at Kenyatta National Hospital to evaluate the presentation, management and outcomes of ACS patients. METHODS: From November 2016 to April 2017, we conducted a retrospective review of ACS cases managed at Kenyatta National Hospital between 2013 and 2016, with a primary discharge diagnosis of ACS, based on International Classification of Diseases (ICD) 10 coding (I20-I24). We compared the presentation, management and outcomes by ACS subtype using analysis of variance testing. We created multivariable logistic regression models using the Global Registry of Acute Coronary Events (GRACE) risk score to evaluate the association between clinical variables, including guideline-directed medical therapy and in-hospital outcomes. RESULTS: Among 196 ACS admissions, the majority (65%) was male, and the median age was 58 years. Most (57%) ACS admissions were for ST-segment-elevation myocardial infarction (STEMI). In-hospital dual antiplatelet (> 85%), beta-blockade (72%) and anticoagulant (72%) therapy was common. A minority (33%) of patients with STEMI was eligible for reperfusion therapy but only 5% received reperfusion. In-hospital mortality rate was 17%, and highest among individuals presenting with STEMI (21%). After multivariable adjustment, higher serum creatinine level was associated with higher odds of in-hospital death (OR = 1.84, 95% CI: 1.21 - 2.78), and STEMI and Killip class > 1 were associated with in-hospital composite of death, re-infarction, stroke, major bleeding or cardiac arrest (STEMI: OR = 8.70, 95% CI: 2.52 - 29.93; Killip > 1: OR = 10.7, 95% CI: 3.34-34.6). CONCLUSIONS: We describe the largest ACS registry at Kenyatta National Hospital to date and identify potential areas for improved ACS care related to diagnostics and management to optimise in-hospital outcomes.
Authors: Julian T Hertz; Francis M Sakita; Godfrey L Kweka; Alexander T Limkakeng; Sophie W Galson; Jinny J Ye; Tumsifu G Tarimo; Gloria Temu; Nathan M Thielman; Janet P Bettger; John A Bartlett; Blandina T Mmbaga; Gerald S Bloomfield Journal: Am Heart J Date: 2020-06-05 Impact factor: 4.749
Authors: Julian T Hertz; Francis M Sakita; Godfrey L Kweka; Tumsifu G Tarimo; Sumana Goli; Sainikitha Prattipati; Janet P Bettger; Nathan M Thielman; Gerald S Bloomfield Journal: Circ Cardiovasc Qual Outcomes Date: 2022-03-18
Authors: Ehete Bahiru; Tecla Temu; Julia Mwanga; Kevin Ndede; Sophie Vusha; Bernard Gitura; Carey Farquhar; Frederick Bukachi; Mark D Huffman Journal: Cardiovasc J Afr Date: 2018-04-20 Impact factor: 1.167