Epidemiology of Cardiovascular Emergencies in the Adult Emergency Department of a Tertiary Hospital in a Resource-constrained Setting of South-Eastern Nigeria

Background: Despite significant progress and advances in the management of cardiovascular (CV) emergencies and the knowledge of its determinants globally, cardiovascular diseases (CVDs) constitute a significant cause of emergency department (ED) hospitalizations especially in a resource-constrained environment.

Aim: The study was aimed at reviewing epidemiology of cardiovascular emergencies in the adult emergency department of a tertiary hospital in a resource-constrained setting of South-eastern Nigeria.

Study Design: This was a retrospective cohort study.

Place and Duration of Study: The study was conducted on patients who presented with diagnoses of CVDs to the ED of Federal Medical Centre, Umuahia, Nigeria over a five year period from January 2008 to December 2012.

Methods: Data sources were from patients’ case notes, medical records, nurses report books and ED admission registers. Information extracted included age, sex, place of the incidence, time of presentation to the ED, month (season) of occurrence and the type of CVDs. Operationally, time of presentation to the ED was categorized into two periods of time: day time was defined inclusively as time period from 6.00 am to 6.00 pm while night time referred exclusively to the time period from 6.00 pm to 6.00 am Nigerian time.

Results: A total of 868 patients were reviewed. There ages ranged from 30 to 95 years with mean age of 62.6±14.4 years. There were 52.9% males and 47.1% females. The incidence of CV illnesses predominantly occurred at home (66.7%), 603 (69.5%) presented during the night time, and 473 (54.5%) occurred during dry season. The three most common CV emergencies were hypertensive crises syndrome (35.9%), acute hypertensive heart failure (32.1%) and acute stroke syndrome (30.7%). Ischemic heart disease constituted 1.3% of the ED hospitalizations.

Conclusion: This study has demonstrated that CV emergencies with hypertensive crises syndrome as well as complications of hypertension (heart failure and stroke) were the most common CV emergency and ischemic heart disease was the least in our centre. The patients affected were predominantly males and elderly patients. Most of the patients lived at home and presentations appeared to occur more frequently during dry season and most presented during the night. The findings of this study signal the urgent need for enhanced and proactive interventions for prevention of hypertension in these groups.