Prevalence and clinical profile of heart failure patients with atrial fibrillation in a tertiary hospital in Kano, Nigeria.

Introduction: Atrial fibrillation (AF) is one of the most prevalent sustained arrhythmias that is seen in clinical practice. AF commonly coexists with heart failure (HF) and there is growing evidence that it confers an adverse prognostic impact on the natural course of the disease. We set out to describe the prevalence and clinical profile of HF patients with AF in Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. Materials and Methods: We conducted a cross-sectional study of all adults aged 18 years and above, who presented at the AKTH, Kano, and were hospitalised for HF. Those who consented were consecutively recruited into the study. Sociodemographic and clinical characteristics of patients at presentation were documented. Thromboembolic risk was assessed using CHA2DS2-VASc scoring system. A 12-lead electrocardiogram recording was obtained from each of the recruited patients to confirm the presence of AF. The prevalence of AF was determined amongst the admitted HF patients. Those with AF were compared with those without AF in terms of sociodemographic and clinical characteristics. Results: A total of 240 Nigerians were recruited. Sixty per cent were female and the whole group had a mean age of 50.85 ± 18.90 years. The prevalence of AF was found to be 12.5% amongst the recruited HF patients. The HF patients with AF had a significantly higher mean age (58 ± 16.7 years vs. 49.8 ± 19.0 years) (P = 0.021), and they also had a higher prevalence of palpitation and body swelling. The mean CHA2DS2-VASc score of the AF patients was 3.4 ± 1.0. Conclusion: AF is prevalent amongst HF patients in our environment with high thrombotic risk. More studies are needed to fully study the prevalence of AF and its clinical profile amongst HF patients in our country.

Choice of antihypertensive medications among physicians and its impact on blood pressure control among Nigerians living with hypertension.

Background: Hypertension, if untreated or uncontrolled, leads to damage of vital organs such as the brain, heart and the kidneys among others. These complications have been shown to be severer in black Africans. Benefit of treatment has been repeatedly demonstrated by many studies. Therefore, many guidelines have been produced by relevant bodies in different countries in order to assist physicians in making the right choices for blood pressure (BP) control. Most of these bodies produce the guidelines based on the peculiarities of hypertension in their respective population. Several reports have shown how different hypertension is, in black Africans, still there is no published unified guideline for its treatment in this population. Methods: This was a survey of known hypertensives who were on follow up visit. Their prescriptions were assessed for drug name, class and number. Their blood pressures at that visit were also recorded. Prevalence of single therapy and combination therapy were determined. Compliance with the AHA recommended 2 ­ drug combination was determined. The percentage of BP control as well as the prescribed drugs in each group were also obtained. Results: Those on single agents were 13% out of which 52% were controlled. 87% were on various combination of 2 or more drugs of whom 41.9% of those on 2 drugs and 21.1% of those on more than 2 drugs had controlled BP. BP control in those on 2 drugs was better than in those with > 2 drugs, (p=0.0027). ACEI were the commonest used drug either as single agent (55.9%) or as 2 ­ drug combination as seen in 54.8% of the subjects on 2 ­ drug combination. 13 different 2 ­ drug combinations were identified with the best control in ARB + Diuretic, ACEI + Diuretic and CCB + Diuretic. The least control was observed in the ACEI + CCB group. Compliance with AHA recommendation was good but still 7.7% were under unacceptable group while another 7.7% were unclassified. Conclusion: ACE-Is are becoming the drugs of choice both as monotherapy and as combination therapy. Despite good compliance to AHA recommendation on drug combination, overall control is still a problem which calls for a revisit of these recommendations in Africans.

Aberrant right coronary artery in an elderly Nigerian with recent dyspnoea detected on coronary CT angiogram.

An anomalous origin of the right coronary artery has been documented in up to 0.92% of the general population, which is more common than an anomalous origin of the left coronary artery. We present a case of an elderly hypertensive man who developed mild dyspnoea on exertion for 3 months with associated retro-sternal pain as well as occasional palpitation which all tend to subside at rest. An electrocardiogram showed evidence of left atrial enlargement. A coronary computed tomographic angiogram was acquired with a 160-slice scanner which revealed the right coronary artery to originate from the left aortic sinus with a retro-aortic pattern of anatomical course. Vascular wall calcifications were noted with multilevel luminal narrowing on the left anterior descending however distal opacification was adequate. Our case further depicts the reason for keeping in mind anatomical variations while evaluating cardiac pathologies even among Black Africans.

Registry for Acute Coronary Events in Nigeria (RACE-Nigeria): Clinical Characterization, Management, and Outcome.

Background Coronary artery disease was hitherto a rarity in Africa. Acute coronary syndrome (ACS) accounts for coronary artery disease-related morbidity and mortality. Reports on ACS in Africa are few. Methods and Results We enrolled 1072 indigenous Nigerian people 59.2±12.4 years old (men, 66.8%) with ACS in an observational multicentered national registry (2013-2018). Outcome measures included incidence, intervention times, reperfusion rates, and 1-year mortality. The incidence of ACS was 59.1 people per 100 000 hospitalized adults per year, and comprised ST-segment-elevation myocardial infarction (48.7%), non-ST-segment-elevation myocardial infarction (24.5%), and unstable angina (26.8%). ACS frequency peaked 10 years earlier in men than women. Patients were predominantly from urban settings (87.3%). Median time from onset of symptoms to first medical contact (patients with ST-segment-elevation myocardial infarction) was 6 hours (interquartile range, 20.1 hours), and only 11.9% presented within a 12-hour time window. Traditional risk factors of coronary artery disease were observed. The coronary angiography rate was 42.4%. Reperfusion therapies included thrombolysis (17.1%), percutaneous coronary intervention (28.6%), and coronary artery bypass graft (11.2%). Guideline-based pharmacotherapy was adequate. Major adverse cardiac events were 30.8%, and in-hospital mortality was 8.1%. Mortality rates at 30 days, 3 months, 6 months, and 1 year were 8.7%, 9.9%, 10.9%, and 13.3%, respectively. Predictors of mortality included resuscitated cardiac arrest (odds ratio [OR], 50.0; 95% CI, 0.010-0.081), nonreperfusion (OR, 34.5; 95% CI, 0.004-0.221), pulmonary edema (OR, 11.1; 95% CI, 0.020-0.363), left ventricular diastolic dysfunction (OR, 4.1; 95% CI, 0.091-0.570), and left ventricular systolic dysfunction (OR, 2.1; 95% CI, 1.302-3.367). Conclusions ACS burden is rising in Nigeria, and patients are relatively young and from an urban setting. The system of care is evolving and is characterized by lack of capacity and low patient eligibility for reperfusion. We recommend preventive strategies and health care infrastructure-appropriate management guidelines.

Laboratory-confirmed hospital-acquired infections: An analysis of a hospital's surveillance data in Nigeria.

OBJECTIVE: Hospital-acquired infections (HAI) are a global problem and a major public health concern in hospitals throughout the world. Quantification of HAI is needed in developing countries; hence we describe the results of a 2-year surveillance data in a tertiary hospital in Nigeria. METHODOLOGY: This study is a 2-year review using secondary data collected at a tertiary referral center in northwestern Nigeria. The data was collected using surveillance forms modeled based on the Centre for Disease Control (CDC) protocol. Descriptive statistics were used to present results as frequencies and percentages. RESULT: 518 patients developed HAI out of 8216 patients giving an overall prevalence of 6.3%. The mean age of the patients was 35.98 years (±15.92). Males constituted 281 (54.2%). UTI 223 (43.1%) was the most prevalent HAI. Overall, E. coli 207 (40.0%) was the most frequent isolates followed by P. aerugenosa 80 (15.4%). There was a high prevalence of cloxacillin resistant S. aureus (67.9%) and gram-negative rods resistant to third-generation cephalosporins. Trimethoprim-sulfamethoxazole resistance across the board was more than 90%. CONCLUSION: There is a high burden of HAI especially UTI in our hospital with resistance to commonly used antibiotics documented.