School of Clinical Medicine (ETDs)

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Subject: search.filters.subject.Hypertension

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    Adherence to the Standard Treatment Guidelines in managing patients with hypertension at Chiawelo Community Health Centre, Gauteng, South Africa
    (University of the Witwatersrand, Johannesburg, 2022-04) Dawduth, Nikkeeta; Torlutter, Michele
    Background: Hypertension is a highly prevalent chronic disease, causing significant morbidity and mortality and is poorly managed and controlled in primary care, with only 24.5 to 56% of patients being controlled. Aim: The aim of the study was to determine health care worker adherence to the Standard Treatment Guidelines in managing hypertensive patients in primary care. Methods: The study was conducted at Chiawelo Community Practice Johannesburg. A retrospective file review was done on 261 hypertensive patients and information extracted to determine whether health care workers performed correct baseline tests at diagnosis; correct investigations were done on ongoing basis; lifestyle modification was addressed; and correct pharmacological therapy was prescribed and titrated. Data analysis included descriptive statistics and bivariate analysis. Results: A total of 77% of participants were female and 23% were male of which 80.5% participants had co-morbidities. Patients were treated by a doctor in 97% of cases; 84.3% by clinical associate, and 0.6% by a nurse only over time. Baseline findings recorded in the file at diagnosis were: weight 65.9%, height 73.2%, potassium 32.2%, BMI 50.2%, abdominal circumference 51.7%, and urine dipsticks 47.9%. Vitals and investigations recorded in the file: BP 99.6%, weight 19.5%, blood glucose 86.6%, creatinine 95.4%, eGFR 94.3% and urine protein 3.4%. Lifestyle modification was recorded for 23.7% and medication adherence was checked and recorded for 36.4% of patients. The correct antihypertensive medications were prescribed in 96.5% of patients but titrated correctly in only 73.5% of patients. 52.8% of patients were controlled on treatment. Conclusion: Adherence to guidelines by health care workers was suboptimal and several aspects of care warrants quality improvement processes.
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    The profile of patients presenting with ST Elevation Myocardial infarction (STEMI) to a regional emergency department in Gauteng, South Africa
    (University of the Witwatersrand, Johannesburg, 2023-11) Kannai, Jerisha; Moodley, Pravani; Botha, Martin
    Reasons for the research: Cardiovascular disease creates a significant health and socio-economic burden and accounts for 17 million deaths worldwide which equates to 31% of global deaths. (1) In addition, premature deaths from cardiovascular disease in the working population are predicted to increase by 41% by 2030. (2) STEMI is a global concern, with growing morbidity and mortality. (3, 4, 5, 6, 7) The continual increase in STEMI cases will burden our society and the economy. (3) There are few studies in South Africa (SA) on the STEMI population. Further baseline data on our population are required to inform efforts to improve our health system, patient care and to work towards international best practice. Aims: a. To describe the demographic characteristics of patients presenting with STEMI. b. To describe the clinical presentation (symptoms, signs, risk factors, time to treatment) of patients presenting with STEMI in a regional public hospital in Gauteng. c. To determine if age, gender, race, time of presentation and level of prehospital care is associated with adverse outcomes or the need for additional interventions. d. To compare outcomes of patients (admission to general ward / Cardiac Care Unit (CCU) / Intensive Care Unit (ICU) / death). Methods: This was a retrospective observational transverse / cross sectional registry study. Data was collected from a STEMI register maintained at the Emergency Department (ED) of Tambo Memorial Hospital (TMH) from June 2018 until 31 July 2020. Major results: In our study 68% of patients were male. The most common ages at presentation ranged from 40 - 69 years old, with a mean age of 54.4 years. The commonest risk factors included: being a smoker (77%), history of ischemic heart disease (71%), hypertension (55%). The highest prevalence - occurred in the Caucasian race group. Our population group was predominantly transported by private means (52%). Only 10.11% of patients scored red on triage and 30.34% scored orange. The mean duration of symptoms was less than 12 hours. The mean time: from door-to-ECG was 38.5 minutes, door- to- doctor’s assessment was 31,4 minutes, door- to-adjuncts was 53,9minutes and door-to-needle was 101.9 minutes. The majority of patients were transferred out of the ED to cardiology (46.87%) and the general ward (40.62%). Conclusion statement: Within the public sector, SA does not have sufficient data on the STEMI population. The aim of this study was to shed light on the population at TMH. It is crucial to treat STEMI patients speedily and effectively. The findings of this study suggest that patients presenting with STEMI at TMH are similar to patients in other studies, but the time to treatment is longer than the recommended target times. These findings suggest room for improvement in the management of STEMI at TMH. Due to a small sample size, we did not have significant results when analyzing the population group requiring special interventions.