A STUDY ON CARDIOVASCULAR DISEASE PATTERN OF ADMITTED CASES IN NEWLY EMERGED NATIONAL HEART CENTRE

A STUDY ON CARDIOVASCULAR DISEASE PATTERN OF ADMITTED CASES IN NEWLY EMERGED NATIONAL HEART CENTRE Cardiovascular disease is one of the global leading causes of death . Although in developed countries overall cardiovascular death is declining due to long term decline of rheumatic heart disease (RHD), cerebro vascular and hypertensive heart disease, heart disease is still the leading cause of death. In developing countries prevalence of coronary heart disease (CHD) is in increasing trend and cardiovascular disease pattern is changing. Cardiovascular disease pattern of this region is revealed in this study. Total 300 study subjects, admitted from May 2000 to April 2001, 174 (58%) male and 126 (42%) female and age ranged from 5 to 83 years were analyzed retrospectively. Proportionate distribution of all admitted cases was calculated and arranged in according with sequence order. Rheumatic heart disease was found the commonest, which constituted 27.3%, followed by coronary heart disease (21.7%) and hypertension (20.7%) respectively. Chronic obstructive pulmonary disease (COPD) with cor pulmonale (7.7%) was fourth in sequence order then respectively came diabetes mellitus (DM) coexisted with CHD or hypertension, dilated cardiomyopathy (DCM), cardiac arrhythmia without organic heart disease, congenital heart disease, infective endocarditis, rheumatic fever, pericardial effusion etc. Readmission rate within one year was 12.3% and mortality rate was 2.7%. Conclusion: Rheumatic heart disease is the commonest heart disease followed by coronary heart disease and hypertension. COPD with cor pulmonale, diabetes coexisted with CHD or hypertension, DCM and cardiac arrhythmia without organic heart disease are also common heart diseases.


INTRODUCTION
Cardiovascular disease is one of the top killer diseases and is problematic for both developed and developing countries.Prevention and treatment of heart disease is becoming an essential and increasing global concern.In developed countries, although mortality trend from total cardiovascular disease has been downward since about 1940, with long term declines for the three cardiovascular disease subgroups; rheumatic, cerebro vascular and hypertensive diseases since the mid 1960s, 1 heart disease is still the leading cause of death followed by cancer. 2,3Increasing trend of cardiovascular disease morbidity and mortality and changing pattern of cardiovascular disease have been reported in some developing countries. 4Hence, the study of prevalence and changing proportion in the disease pattern of cardiovascular diseases is becoming an essential concernment.Shahid Gangalal National Heart Centre is newly emerged leading national hospital for the management and research of cardiovascular diseases. 5Previous well-documented studies on the disease pattern of cardiovascular disease in Nepal are not available.The aim of this study is to investigate the disease pattern of admitted cardiovascular disease cases within one year in this National Heart Centre and to speculate the future concern of the nation for the management of cardiovascular diseases on the basis of investigation outcome.

METHODS
Disease pattern of total 300 cases, who were admitted from May 2000 to April 2001, was retrospectively investigated from the hospital admission book.The age of study subjects ranged from 5 to 83 years, which included 174(58%) male patients and 126(42%) female patients.
Proportionate distribution of the disease pattern of admitted cases in National Heart Centre was calculated.Total number of RHD cases associated with mitral stenosis (MS) was identified and mean age of rheumatic MS cases was calculated to compare with previous studies on rheumatic MS carried out in Nepal. 6,7Readmission and mortality rate within one year was calculated and disease associated with hospital death was identified from the hospital admission book.

RESULTS
Total 300 cases 174(58%) male and 126(42%) female patients age ranged from 5 to 83 years were admitted within one year.The number of RHD cases was the highest.RHD constituted the highest in proportion (27.3%) followed by CHD (21.7%) and hypertension (20.7%).Disease pattern of admitted cases with patient numbers and percentage in sequence order are demonstrated in the table I.
Quite significant number (7.7%) of COPD with cor pulmonale cases were also admitted.The number of diabetic cases coexisted with hypertension or CHD was also not very small, that possessed almost 4% of total admitted cases.Number of cardiac arrhythmia without any organic heart diseases was 9, which was 3% in the proportion of total admitted cardiovascular cases and 7th in sequence order.Total 8 cases of congenital heart diseases, which ranked 8th in sequence order, were admitted that contained 4

DISCUSSION
This discrepancy is mainly due to number of first admission cases in this newly emerged national heart centre were enrolled in this study, who were previously admitted and treated in other hospitals, whereas in previous study 6 the mean age of first admission due to symptomatic rheumatic mitral stenosis was calculated.Sex distribution of this study nearly accord with previous studies carried out in this country. 6,7,12ronary heart disease is detected as the second commonest heart disease from this study.Increasing trend of CHD in hospital admitted cases was reported some ten years back in this city, 13 whereas CHD is the leading cause of death in adults in developed countries. 14Recently CHD is also reported as the commonest heart disease in some developing countries. 8Most common coronary presentations are angina and myocardial infarction, which leads for the hospital admission.Prevalence of CHD in this country is not reported previously.
It is obvious from the study that CHD is one of the commonest heart diseases among all cardiovascular diseases.
Prevalence of hypertension, especially among adults and elderly population is common.It is reported up to 24 percent in some developed countries 15 and in developing countries the prevalence varies from 3 percent to 27 percent in rural and urban areas. 16,17Hypertension is one of the risk factors of CHD and it closely associates with CHD.Twenty percent admitted cases, third commonest cause of hospital admission, are hypertensive patients according to the data analysis of this investigation.Some ten years back in one retrospective study carried out in this city Acharya et al 18 had reported hypertension as the commonest cause of hospital admission among all cardiovascular diseases.Isolated hypertension can be managed in out patient follow-ups, so we speculate the percentage of inpatient hypertensive cases among all cardiovascular diseases will be decline in future.
This investigation shows; RHD, CHD and hypertension are three commonest heart diseases, which constitute 70 percent of all admitted cardiovascular diseases.COPD with cor pulmonale is the 4th commonest disease, which makes 8 percent of total admitted cases in this study, while in previous one study 18 Better outpatient management of hypertension, stable CHD and heart failure will accumulate more inpatient congestive heart failure cases in future.No trend of decline in RHD can be predicted due to lack of recent comparative studies on the prevalence of RHD, which comes first in the sequence order of this study.Finally, this study provides the picturesque view of the disease pattern of cardiovascular diseases.Rheumatic heart disease is the commonest heart disease.Coronary heart disease and hypertension are also major heart diseases.COPD with cor pulmonale, diabetes coexisted with hypertension or CHD, dilated cardiomyopathy and cardiac arrhythmia without organic heart disease are also common cardiovascular diseases.The overall findings of this study reflect the cardiovascular disease pattern of this region.