The Demographics of Cardiovascular Mortality Among Cardiac Patients admitted in a Cardiac Intensive Care Unit (2010-2017) at the Charlotte Maxeke Johannesburg Academic Hospital

Abstract

The purpose of this retrospective study was to describe the demographic and clinical characteristics, laboratory biochemical findings and the prevalence of associated risk factors among patients with coronary artery disease, who demised in the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) Coronary Care Unit (CCU) during the period 2010–2017. Overview Cardiovascular diseases (CVDs) are the leading cause of death globally, with more than four out of five CVD deaths being attributable to stroke and heart attack. The prevalence of total CVD cases has almost doubled from 271 million in 1990 to 523 million in 2019. Furthermore, it is estimated that 17.9 million people died from CVDs in 2019, representing 32% of all global deaths. An increase in non-communicable diseases (NCDs) has been noted in sub-Saharan Africa (SSA), with a higher incidence in CVDs noted to be affecting the general SSA population. Of the top ten causes of natural death in South Africa, CVDs ranked third and showed an increase over the past years. In 2011, the Word Economic Forum (WEF) projected a US$47 trillion loss in economic output by 2030 due to the increasing burden of NCDs. A reduction in mortality from acute myocardial infarction (AMI) has occurred with the development of the coronary care unit (CCU). The CCU has been termed the most significant innovation in cardiology concerning the management of AMI. Its contribution to the decrease in mortality from AMI has been well documented in the literature over the past 30 years. However, the CCU has evolved remarkably over the past decades. The modern-day CCU has transformed into a blended integration between the CCU and cardiology wards, and CCU and intensive care units (ICU) or high care units. Cardiologists must be trained and competent in skills generally mastered by ICU specialists, such as the management of septic shock, critical illness neuropathy, renal replacement therapy (RRT), provision of ventilatory support and neuropsychiatric complications such as delirium. Despite the increasing burden of NCDs and the changing face of the CCU, SSA is still confronted with an insufficient healthcare infrastructure, poor delivery systems, lack of specialist cardiology services and drug shortages. There is a severe shortage of percutaneous iv coronary intervention (PCI) capable facilities in South Africa, with a total of less than 70 facilities in both the public and private healthcare sectors. Currently, there is no standardised source of data for CVD mortality in SSA and, in particular, South Africa. Locally, there is also a paucity of data reporting mortality rates in CCUs, with specific emphasis on risk factors related to acute coronary syndrome (ACS). This study provides vital information regarding the demographic and clinical characteristics, biochemical parameters and risk factors of the non-surviving patients admitted to a modern- day CCU. The aim of the study was to contribute towards the development of management guidelines, resource allocation, employing severity scoring systems for predicting mortality in the CCU population, as well as developing patient selection criteria for CCU admission based on mortality risk scoring, to improve overall patient care. In this retrospective study, a cohort of patients who died at the CMJAH CCU from January 2010 to December 2017 was identified. Data were collected from the patients' CCU discharge summary forms and the cardiology department database. Data from this study will be submitted for publication in the Cardiovascular Journal of Africa and presented to the relevant health authorities.