Magnitude and Pattern of Cardiovascular Diseases in Saint Peter’s Specialized Hospital from July 2017 to June 2021, Addis Ababa, Ethiopia

Introduction: Cardiovascular diseases are the leading cause of death worldwide. Approximately 18 million people die each year from cardiovascular diseases, an estimated 32% of all deaths worldwide. In more than 75% of cardiovascular diseases, deaths occur in low- and middle-income countries, and 85% of all cardiovascular disease deaths are due to heart attacks and strokes. In Ethiopia, cardiovascular diseases accounted for 16% of all deaths in 2018 and were the leading cause of death. Cardiovascular diseases are fatal and can lead to serious illness, disability, and compromised quality of life. This data analysis aimed to assess the magnitude and pattern of cardiovascular diseases in Saint Peter’s Specialized Hospital, Addis Ababa, Ethiopia.

Method: A descriptive cross-sectional study was conducted from June 9, 2022, to June 29, 2022 to analyze four years cardiovascular disease data covering the period from July 2017 to June 2021. The data was reviewed and analyzed by Excel 2016. The results are summarized as counts, proportions, ratios and means and are illustrated by tables and graphs.

Results: In Saint Peter’s Specialized Hospital, hypertension accounted for 46.9% (8182) CVD. Coronary heart diseases and heart failure accounted for 22.9% and 20% respectively among cardiovascular diseases. Cerebrovascular diseases and heart failure accounted for 74% of deaths from cardiovascular diseases, followed by ischemic heart diseases, which accounted for 22% of deaths. Cardiovascular diseases accounted for 74.3% of deaths from noncommunicable diseases and 16.9% of deaths from all deaths.

Conclusion: Hypertension, heart failure, and ischemic heart disease were the three most frequent cardiovascular diseases. Heart failure and cerebrovascular diseases are the leading causes of death. Among noncommunicable diseases, cardiovascular diseases are the leading cause of death. Cardiovascular diseases account for three-fourths of noncommunicable diseases and responsible for a significant number deaths in the hospital, so the hospital places more emphasis on cardiovascular diseases prevention, treatment, and control.

Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels. Cardiovascular diseases (CVDs) include coronary heart disease, cerebrovascular disease, rheumatic heart disease and other conditions [1]. Before 1900, infectious diseases and malnutrition were the most common causes, and CVDs were responsible for <10>

Saint’s Peter Specialized Hospital is one of the oldest public hospitals in Addis Ababa, Ethiopia and was established in 1953. It is found in woreda 01 of Gulele subcity, northern Addis Ababa. The hospital was a national tuberculosis diagnosis and treatment Centre until 2005. Currently, the hospital is providing comprehensive health care services at the outpatient and inpatient levels. The hospital has NCD treatment, prevention and control services. It is one of the 74 Resolve to Save Lives (RTSL) sites in Ethiopia. It has one NCD OPD, which serves only patients with NCD including CVD. It has also provided inpatient services, including CVDs, in the inpatient department. The hospital is under FMOH and there is no defined cluster population. Descriptive cross-sectional study was conducted from June 9, 2022 to June 29, 2022. Four years, i.e., July 2017 to June 2021, of Saint Peter’s Specialized Hospital CVD data were analysed. All CVD cases and deaths reported via the district health information system (DHIS2), i.e., 17,441 composed the study populations. Patients who were diagnosed with one or more cardiovascular diseases at Saint’s Peter Specialized Hospital were the source population. All cases and NCD cases in the study period were extracted from DHIS2 by using a checklist. Cardiovascular disease data were extracted based on age category, sex, department, time and outcome with the type of CVD. Each category’s data were extracted with the type of CVD separately. The extracted data were checked for possible missing CVD values and segregated based on the international classification of disease codes. The data extracted from DHIS2 analyzed with Excel 2016, and the results are summarized as the mean, count, proportion, and ratio and are shown in tables and graphs. The official letter, which was written by the Ministry of Health, was submitted to Saint Peter’s Specialized Hospital. The Proposal was prepared and submitted to Saint Peter’s Specialized Hospital Research and Evidence Generation Directorate. The directorate approved and provided ethical clearance for data analysis.

Magnitude and types of CVD morbidities

From July 2017 to June 2021, a total of 337,810 cases were reported via DHIS2 in the hospital. Among the total cases, NCDs accounted for 31,346 (9.3%). Among NCD cases, CVDs accounted for 17,441 (55.6%).

Distribution of CVD morbidities by person 

Among CVDs, HTN accounted for 8182 (46.9%) and IHD and heart failure (HF) accounted for 4001 (22.9%) and 3,484 (20%), respectively. The majority of the 9803 (56.2%) CVD patients were female. Half of the cases, 8943 (51.3%), were aged 30 to 64 years (Table 1).

Table 1: Magnitude of CVDs by person in Saint Peter’s Specialized Hospital from July 2017 to June 2021, Addis Ababa, Ethiopia, 2022.

CVDs*-Cardiovascular diseases, HTN**-Hypertension, IHD***-ischemic heart disease

Distribution of CVD Morbidities by time 

Approximately half of the cases, i.e., 8652 (49.6%) cases, were reported in 2018/2019. The lowest number of cases, 1603 (9.2%) reported in 2020/2021. On average, 4320 cases of CVD were reported annually. Regarding HTN, nearly half of the cases, i.e., 3751 (45.8%), and fewest, 926 (2.6%), were reported in 2018/19 and 2020/21, respectively. On average, approximately 2045 cases occur annually. Nearly two-thirds of the cases, 2549 (63.7%), were reported in 2018–19, while the lowest, 99 (2.5%), reported in 2020–21, respectively. On average, 1,000 cases of IHD are reported annually (Figure 1).

Figure 1: Patten of CVDs by time in Saint Peter’s Specialized Hospital from July 2017 to June 2021, Addis, Ethiopia, 2022.

Distribution of CVD Morbidities by departments 

The outpatient department accounted for 15,321 (87.8%) CVD cases and the rest were inpatients. The highest cases (89.3%) of outpatient departments were reported in 2018/19 and the lowest (80.5%) was in 2020/21. From IPD case 38.5% of CVDs, cases were ischemic heart diseases (IHD) (Table 2). From OPD cases, 52.4% of CVDs cases were HTN. Heart failure (HF) and ischemic heart disease (IHD) accounted for 18.3% and 17.8% of CVD OPD cases respectively. Heart failure (HF) and cerebrovascular diseases accounted for 31.8% and 13.3% of CVDs IPD cases respectively (Figure 2).

Figure 2: Patten of CVD by department in Saint Peter’s Specialized Hospital from July 2017 to June 2021, Addis Ababa, Ethiopia, 2022.

Table 2: CVD cases by department at Saint Peter’s Specialized Hospital from July 2017 to June 2021, Addis Ababa, Ethiopia, 2022.     

Mortality of CVD

During the review period, a total of 943 deaths were reported in the hospital. Among the total deaths, NCDs accounted for 214 (22.7%) deaths. Among the NCD deaths, CVD accounted for 159 (74.3%) of the deaths and it accounted 16.9% of among all deaths.

Pattern of CVD mortalities

Cerebrovascular diseases and heart failure accounted for 74% of CVD related deaths followed by IHD which accounted for 22% of CVD related deaths. Other CVDs accounted for only 4% of the deaths (Figure 3).

Figure 3: CVD mortality pattern in Saint Peter’s Specialized Hospital from July 2017 to June 2021, Addis Ababa, Ethiopia, June 2022.

Distribution of CVD mortality by time 

The highest number of deaths [59] reported in 2017/18 accounted for 37% of the total cases. On average, 40 cases of death are reported annually. Figure 4 shows the annual mortality of CVDs.

Figure 4: Trend of CVDs in Saint Peter’s Specialized Hospital from July 2017 to June 2021, Addis Ababa, Ethiopia, 2022.

Four years, i.e., from July 2017 to June 2021, CVD data of Saint Peter’s Specialized Hospital were retrieved and analyzed from June 9 to June 29, 2022. A total of 17,441 cases of CVD were reported. Among CVDs, HTN was the leading cause, accounting for 46.9%, followed by IHD and HF. IHD and HF accounted for 22.9% and 20%, respectively. Cardiovascular disease accounted for 74.3% of deaths from NCDs and 16.9% of deaths from all deaths. The trend of CVD morbidity decreased, whereas overall mortality tended to increase. Cerebrovascular diseases and heart failure accounted for 74% CVD deaths, followed by IHD, which accounted for 22% of CVD deaths. Hypertension was the leading cause of CVDs, which is similar to findings of the study conducted at Gondar University Referral Hospital but a study conducted at Saint Paul Hospital Millennium Medical College showed that congestive heart failure (60%) was the leading cause (16,20). A study conducted at Tikur Anbessa Specialized University Teaching Hospital in 2014 revealed that HTN (14.7%) and HF (9.1%) were among the most common diagnoses, but the leading diagnosis was valvular heart disease (62.0%) [21]. A study conducted in cardiology clinics of six referral/teaching hospitals in the country also showed that Valvular heart disease was the most common diagnosis, accounting for 40.5% of the cases [22]. Another study conducted at Ayder Comprehensive Specialized Hospital showed that rheumatic valvular heart disease is the leading cause of CVD (41.1%) CVDs [23]. This may be due to the differences in scope of the services, sample, source of the data and mean age of the participants.

According to our data analysis, IHD was the leading cause of admission, accounting for 38.5%, followed by HF (31.8%) and cerebrovascular diseases (13.3%). A study conducted in admitted patients at the Nepal Tertiary Care Teaching Hospital showed that 35% of CVDs were IHD, followed by hypertension (22.8%) and arrhythmia (13.4%) [24]. In this study, HF and cerebrovascular diseases were the second and third most common causes of admission, respectively, and are lower than those reported in a study conducted at the University of Port Harcourt Teaching Hospital, Nigeria, which showed that the most common CVD was heart failure (43.1%) and cerebrovascular accident (CVA) (24.3%) [25]. Cardiovascular diseases accounted for 16.9% of all deaths, which was consistent with the national figure, i.e., 16% [6]. The incidence of CVD increased from 2017/18 to 2018/19, and then decreased, but other studies have shown that CVD incidence is increasing [26,27]. This may be due to the COVID-19 pandemic. WHO assessments showed that NCD services and screening are compromised due to the COVID-19 pandemic (28).  Other studies also show that COVID-19 had a significant effect on decreases in CVDs and other health services (13,19). The source of this data analysis was DHIS2, which may have missing values during data entry or incorrect entry of data. Hypertension and HF were the two most frequent CVD cases while HF and cerebrovascular diseases are the leading causes of death. Among NCD, CVD is the leading cause of deaths. These data analysis showed that CVD accounted for three-fourths of deaths from noncommunicable diseases and a significant number of deaths from all deaths in the hospital, so the hospital places more emphasis on CVD prevention, treatment and control.

CDC, Centres for Diseases Control and Prevention; 

CVDs, Cardiovascular Diseases; 

DVHD, Degenerative Valvular Heart Disease; 

DCMP, Dilated Cardiomyopathy; 

DHIS, District Health Information System; 

EFETP, Ethiopia Field Epidemiology Training Program; 

HF,  Heart Failure; IHD, Ischemic Heart Disease; 

IPD, Inpatient Department; 

HHD, Hypertensive Heart Disease; 

HTN, Hypertension; 

NCD, Non-Communicable Disease; 

OPD, Outpatient Department; 

RVHD, Rheumatoid Valvular Heart Disease Arrhythmia; 

RTSL, Resolve To Save Lives; 

SSA, Sub-Saharan Africa

Acknowledgments

I acknowledge Saint Peter’s Specialized Hospital for allowing this data analysis. I also acknowledge Saint Paul’s Hospital Millennium Medical College, Ethiopia Field Epidemiology Training Program coordinators. I would like to acknowledge Aman Yesuf, Dr. Yosef Worku and Henok G/Yohannes (Addis Ababa Resolve to Save Live coordinator) for their guidance and critical comment of the output.

Availability of data and materials

Most data are available in the paper. Additional data will be shared upon request. 

Ethics approval and consent to participate

Not applicable

Authors’ contributions

Nigus Goshim designed the research and wrote the manuscript.

Competing interests

The author reports no conflicts of interest in this work.

Consent for publication

Not applicable.

Author information

St. Paul’s Hospital Millennium Medical College, School of Public Health, Department of Field Epidemiology, Addis Ababa, Ethiopia.