Trend in Hospital Admissions for Cardiovascular Diseases (CVDs) before and during the Coronavirus Disease 2019 (COVID-19) Pandemic: A Retrospective analysis from a Sub-urban area in sub-Saharan Africa

Trend in Hospital Admissions for Cardiovascular Diseases (CVDs) before and during the Coronavirus Disease 2019 (COVID-19) Pandemic: A Retrospective analysis from a Sub-urban area in sub-Saharan Africa | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Trend in Hospital Admissions for Cardiovascular Diseases (CVDs) before and during the Coronavirus Disease 2019 (COVID-19) Pandemic: A Retrospective analysis from a Sub-urban area in sub-Saharan Africa Gaetan Kwasseu Konfo, Clovis Nkoke, Kenfack Kuaguim, Anastase Dzudie This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5341959/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The COVID-19 pandemic was a global public concern and constitute a future threat to the world population due to its indirect effect on the burden of non-communicable diseases. The pandemic manifested disruptions in health care delivery and access. However, there is limited data in Sub-Saharan Africa on the impact of the COVID-19 on cardiovascular disease (CVD) admissions and outcomes. Objectives To compare the trends of CVD admissions and outcome before and during the COVID-19 pandemic in the Southwest Region of Cameroon. Methods We carried out a retrospective study of patients suffering from CVDs admitted from March 11 2018 to March 11 2020 (Pre-COVID-19 pandemic period) and from March 11 2020 to March 11 2022 (COVID-19 pandemic period). A p-value < 0.05 was considered statistically significant. Results There were 483 admissions due to CVDs during the COVID-19 pandemic period and 518 during the pre-COVID-19 period. There was no significant difference in mean age before (57.97 ± 15.6 years) and during the pandemic (59.74 ± 16.1years) (P = 0.44).There was also no significant change in the proportion of males and females during and before the pandemic: males (21, 4% and 24.8%), and females (26.8% and 27%), (P = 0.28). There was a downward secular trend with random variation of the number of CVDs admissions during the COVID-19 period when compared with the corresponding pre-COVID period which had an upward trend. Rates of admissions of Acute Myocardial infarction decreased the most (22.2%), and pericardial disease increased the most (14.3%) during the first wave of the pandemic. The in-hospital mortality increased by 2.4% and there was no change in median length of hospital stay (p = 0.936). Conclusion This study provides evidence of a decreasing tendency in admissions due to CVDs during COVID-19 Pandemic at the BRH, and its effects varied among the different types of CVDs. The in-hospital mortality of CVDs increased during the pandemic. Figures Figure 1 Figure 2 BACKGROUND Non communicable diseases (NCDs) contribute about 70% of deaths worldwide with about 80% occurring in low- and middle-income countries [ 1 ]. NCDs more notably cardiovascular diseases (CVDs) is a leading cause of death and disability globally affecting more cases each year than all other causes combined [ 2 ]. Due to its chronic and sometimes life-long nature, CVDs often require repeated interactions with health systems, and not receiving the care needed often results in devastating consequences for persons living with these conditions [ 3 ]. Since the declaration of the corona virus disease 2019 (COVID-19) pandemic, the trends in NCDs admissions have changed over the world [ 4 ]. This is because despite its direct effect on global health, it also had indirect effects on the morbidity and mortality through changes in behaviours of patients and health care providers in addition to the re-organization of health systems [ 4 ]. The pandemic constitutes a future public health threat as people with NCDs such as CVDs interrupted their treatment, leading to an increased risk of complications due to poor control of their chronic condition. Studies published in western countries showed a reduction in cardiovascular consultations and admissions during the COVID-19 Pandemic [ 5 ][ 6 ][ 7 ]. In low- and middle-income countries (LMICs) such as Cameroon, it is likely that with the resource-limited healthcare systems and healthcare inequities, these countries would be poorly equipped to deal with the challenges of the global pandemic. However, data is lacking to confirm this in Africa at large, and Cameroon in particular. The few studies available reported a reduction in the delivery of cardiology services and the majority of services adjusted to the pandemic [ 8 ][ 9 ]. This is because many patients no longer consult for CVD because of the fear of being infected by COVID-19 in hospitals. Since the declaration of the first case of Covid-19 in Cameroon, there have been an increase rate of new cases, and high mortality rate [ 10 ]. This has mounted fear and doubt in the population, and resulted in people deserting the hospitals [ 9 ]. With the rising and unmet CVD burden in Cameroon and the rebound of cardiovascular admissions and mortality due to CVDs globally, there is a need to understand its indirect effect on CVDs diseases for both disease burden and health service provision [ 5 , 8 , 9 ]. This work therefore compared the trend of CVDs before, and during the COVID-19 outbreak in the Southwest region of Cameroon. This will help the policy makers to develop strategies to address thus burden and prepare effectively for any future similar pandemic. METHODOLOGY Study setting and design We conducted a retrospective study on patients admitted at the Internal Medicine Department of the Buea Regional Hospital (BRH) from March 11 2018 to March 11 2020 (Pre COVID-19 Pandemic), and March 11 2020 to March 11 2022 (During COVID-19 Pandemic). The BRH is a secondary level hospital that serves as the main referral centre for patients suffering for CVDs in the Southwest region of Cameroon. It has a capacity of about 111 beds and a catchment population of about 200, 000 inhabitants. The Internal Medicine Department has a consultant cardiologist, two internists, and general practitioners who manages CVDs using appropriate and standard methods. This facility also serves as a diagnostic and treatment center for patients suffering from the COVID-19 infection. Buea is the Head Quarter of the Southwest region of Cameroon. It is a semi urban setting with main economic activity as agriculture [11]. Data collection We collected data on patients admitted for CVDs at the BRH two years before and after the declaration of COVID-19 as a pandemic in Cameroon. The data collection form designed using Epi info version 7.2.5.0, and was used to extract data from the hospital records of affected patients. After identifying the records of each patient suffering from a CVD, the diagnosis on entry was identified. The progress in the ward, the investigations made and the final diagnosis of CVD made by the specialist on discharge was noted. We included records of patients with the diagnosis of the CVD of interest. We excluded those with no clear diagnosis of CVD in the file. The following data was collected: Sociodemographic data: age, gender, occupation, and comorbidities; Clinical data: final diagnosis of the patient (type of cardiovascular disease and subtype); Outcome: final outcome of the patients (death, full recovery, sequelae, or partial recovery discharge), and duration of hospitalisation. We considered the following CVDs: stroke, heart failure, acute myocardial infarction, uncontrolled hypertension, pericardial disease, arrhythmias, and venous thromboembolism. Patients informations were coded to ensure confidentiality. Sample size and statistical analysis A convenient sampling of all eligible participants was considered for this study. The data was analysed using SPSS v25. Continuous variables were presented as mean, standard deviations and graphs, and the Student T-test was used to test for differences between two categories of normally distributed continuous variables. Bivariate analysis was done for categorical variables, and Chi-square test was performed. A P value of <0.05 was considered statistically significant. All reported P-values were based on a two-sided hypothesis. RESULTS The mean age of patients admitted with a CVD was 57.97 ± 15.60 years during the Pre-COVID 19 pandemic period compared to 59.74 ± 16.10 during the COVID 19 pandemic period (p = .442).The number of males during the pandemic was 215(21.5%) compared to 248(24.8%) before while that of females was 268(26.8%) during the pandemic compared to 270(27%) before, giving a male to female ratio during COVID 19 pandemic of 0.9 compared to 0.8 during pre-pandemic period. There was a downward secular trend with random variation of the number of CVDs admissions during the COVID-19 period starting from march 2020 as compared with the corresponding pre-COVID period which had an upward trend ( Figure 2 ). There was a more drastic drop of admissions in the months of April to June 2020 and from April to August 2021 ( Figure 2 ). Overall the rate of admissions of stroke decreased by 5.4%, Uncontrolled hypertension by 27.4%, pericarditis 66% and arrhythmias 28.2%, while Heart failure admissions increased by 0.6% and acute MI by 3.4%. ( Table 1 ). During the first wave of COVID-19 pandemic from march to September 2020, there was a 3% decrease in proportions of stroke, 7.2% decrease in proportion of uncontrolled hypertension, 22.2% decrease in acute MI admissions, and a 4.4% decrease in admissions due to venous thromboembolism compared to the corresponding period before the pandemic. There was also an increase in the proportion of heart failure by 3.5% with 5.2% and 14.3% respective increase in admissions due to arrhythmias, and pericardial disease when compared to the corresponding period pre-COVID period. ( Table 2 ). The in-hospital mortality rate for patient suffering from CVDs was 15.3% during the pandemic and 12.9% before the COVID-19 pandemic (P=0.446). Patients suffering from heart failure and stroke had the highest mortalities before and during the pandemic. ( Table 4 ) There was no difference in the median length of hospital stay before and during the COVID-19 pandemic [7 (3-10) days vs 7(4-10) days, (P=0.936)] ( Table 3 ). Table 1: Proportions of CVDs before and during Covid-19 Pandemic Variables N(total) Pre-COVID-19 period(march 11 2018-march 11 2020)(%) During COVID-19 period(march 11 2020-march 11 2022)(%) P-value Cardiovascular disease Stroke 338(31.6%) 160(47.3) 178(52.7) 0.046 Heart failure 346(32.3%) 174(50.3) 172(49.7) 0.502 Uncontrolled hypertension 234(21.9%) 85(36.3) 149(63.7) <0.01 Acute MI 29(2.7%) 15(51.7) 14(48.3) 0.998 Pericardial diseases 12(1.1%) 2(16.7) 10(83.3) 0.014 Venous thromboembolism 34(3.2%) 17(50) 17(50) 0.836 Arrhythmias 64(6.0%) 23(35.9) 41(64.1) 0.009 MI: Myocardial infarction Table 2: Proportions of different cardiovascular diseases Cardiovascular disease 1 st wave COVID-19 n=159 Frequency(%) Corresponding period n=168. Frequency(%) P-value Stroke 45(17.2) 53(20.2) 0.052 Heart failure 64(22.5) 54(19) 0.004 Uncontrolled hypertension 32(20.9) 43(28.1) 0.175 Acute MI 1(5.6) 5(27.8) 0.607 Pericardial disease 3(21.4) 1(7.1) 0.521 Venous thromboembolism 3(13) 4(17.4) 0.648 Arrhythmias 11(19) 8(13.8) 0.396 MI: myocardial infarction, n=total number of admissions, 1 st wave of COVID-19 in Cameroon: March 2020 to September 2020 Table 3: Outcome of cardiovascular diseases Outcome, n (%) Total n=1001 Frequency(%) Pre-COVID 19 period n=518 Frequency(%) During COVID-19 period n=483 Frequency(%) P-value Alive/Discharged 857(85.6) 450(86.9) 407(84.3) 0.446 Death 141(14.1) 67(12.9) 74(15.3) Transfer to other facilities 3(0.3) 1(0.2) 2(0.4) Median length of hospital stay in days 7.00 7.00 7.00 0.936 Interquartile range of length of hospital stay in days 4-10 3-10 4-10 n=total number of admissions Table 4: Mortality due to different CVDs Cardiovascular disease In-hospital mortality before COVID N (%) In-hospital mortality during COVID N (%) P-value Stroke 25(15.6) 28(15.7) 0.222 Heart failure 28(16.1) 31(18.0) 0.128 Uncontrolled hypertension 9(6.0) 4(4.7) 0.003 Acute MI 1(6.7) 3(21.4) 0.463 Pericardial disease 1(50.0) 3(30.0) 0.118 Venous thromboembolism 4(23.5) 4(23.5) 0.186 Arrhythmias 4(17.4) 7(17.1) 0.515 MI myocardial infarction DISCUSSION This study demonstrates a reduction in Hospital Admissions for CVDs during the COVID-19 in an internal medicine service of a sub urban city of Cameroon. Three major findings must be outlined. 1) No significant difference in the mean age at admission and male to female ratio before and during the pandemic. 2) a falling trend of CVD admissions during COVID-19 period, with a more drastic drop of admissions in the months of April to June 2020 and from April to August 2021. 3) The overall in-hospital mortality of patients with CVDs had an increasing tendency during the pandemic, but there was no change in median length of hospital stay during the two periods. Patients suffering from heart failure and stroke had the highest mortalities before and during the pandemic. The COVID 19 pandemic constitutes a future public health threat as people with chronic NCDs interrupt their treatment, leading to an increased risk of complications due to poor control of their chronic condition. The goal of our study was to evaluate the trend in CVD admission and outcome before and during the COVID-19 pandemic at the Buea Regional Hospital. This will help the Ministry of Health and other policy makers to take better decisions and strategies in order to improve CVD outcomes in case of other waves of the COVID-19 pandemics and future pandemics if need arises. Physicians expressed grave concern regarding the potential rise in cardiovascular patients in hospitals as a result of presentations that were either stable or previously undetected throughout the epidemic. Furthermore, as a result of this crisis, there may be an increase in patients experiencing delayed consequences from ACS and reinfarctions in the near future. [ 7] The falling trend of CVDs admissions starting from March to June 2020 in Cameroon, can be explained by several factors, the fear of contracting COVID-19 virus which is known to be highly contagious by the population and thus most patients preferred to stay away from hospitals [ 12 ]. Also this reduction could be due to the fact that some patients were scared that in the event of death they will be buried immediately without them receiving proper last respect from their family members and loved ones [ 9 ]. This is because in Africa, mourning of the deceased is considered very important and the way it is approached is different from that in the western countries[ 9 , 13 ].This period also coincide with the time when the government implemented 19 measures during lockdown in order to limit the spread of the virus including restricting access to public spaces[ 14 ].Also, with the advent of Covid-19 vaccine, patients were scared and anxious in getting the vaccine and so preferred to avoid going to the hospitals. This might have contributed to the reduction of people seeking for healthcare during this period. Health care reconfiguration of both primary and secondary care by sudden cessation of routine-face to face appointments, interruption of established care pathways and reduced availability of medical staffs has also contributed to the reductions in cardiovascular diseases consultations[ 15 ]These findings are similar to those in a study carried out in Brazil by Normando PG et al which showed a 15% drop in admissions of cardiovascular disease during COVID-19 pandemic[ 16 ].Also a crossectional e-survey conducted among cardiologist in Africa by Chris Nadege Nganou et al showed a reduction in the number of consultations due to cardiovascular diseases during COVID-19 in Africa [ 9]. This decrease is also demonstrated in other disciplines as evident by a decrease in paediatric admissions during COVID-19 outbreak in Cameroon [ 9 ].The drop in the proportion of stroke (3%), uncontrolled hypertension (7.2%), MI (22.2%) and venous thromboembolism(4.4%) during the first wave of the pandemic, might be due to the fact that this was the early phase of the pandemic little was known about the disease at this time and the fear of contracting the disease by the population was at its peak during this period [ 13,17].This result is similar to that obtained in Qatar by Akhtar N et al which showed a decrease in admissions due to stroke from 87 to 34 per month during the early phase COVID-91 pandemic.[ 18] The increase in proportion of heart failure 3.5%, arrhythmias 5.2% ,and pericardial disease 14.3% during the first wave might be due the fact that this period coincides with the lockdown period which was associated with increased risk of cardiovascular disease by promoting an increases in unhealthy eating habits, decreases in physical activity and stress[ 19 , 20 , 21 , 22 ], An increase in tobacco usage was also noted in Italy, India, South Africa, the UK, and the USA during the COVID-19 lockdown[ 23 ].However, this result contradict that of Hall ME et al who showed a considerable decrease in the admissions due to heart failure from march to April 2020 [ 24 , 25 ].The overall increase in in-hospital mortality as shown in our study may be explained by the fact that patients delayed in seeking medical care and thus being hospitalized in more severe conditions. [ 16] Delay in seeking medical care during this period was noted in many hospitals over the world including developed countries [ 26] and this might have occurred due to different reasons that is financial difficulties or the use of alternative traditional medicines in our case [ 19,27, 28]. Also Increase in cardiovascular risk factors such as physical inactivity, improper eating habit, tobacco usage and alcohol misusage may have increased the rate of CVD related premature deaths during this period [ 20 , 21 , 22 , 23 , 24 ], this result is similar to that in a study carried out in Italy by De Rosa S et al which showed an increase in the case fatality rate of acute MI during the pandemic. [29, 30], Another study carried out in Cameroon on paediatric admissions by Chelo D et al showed a doubling of the mortality rate in children during COVID-outbreak compared to before [ 9]. STRENGTH AND LIMITATIONS Our study's unique methodological strengths, which guarantee its validity and facilitate the interpretation of data, are as follows: (i) comparisons were done between the relevant periods of the pandemic such as during the first wave with the corresponding Periods. However, Patients with severe cardiovascular diseases might have died home even before reaching the hospital and so this study may have underestimated the occurrence of cardiovascular diseases as they will not be registered in the hospital registries. This study provides valuable information on the epidemiology of cardiovascular diseases before and during the Covid-19 pandemic. CONCLUSION This study shows a falling Trend in the number of admissions due to cardiovascular disease during the COVID-19 Pandemic at the BRH, with an increase in mortality due to cardiovascular diseases during the pandemic. This data supports the fact that health care utilization might have reduced during the Pandemic and this may be due to patients fear of medical facilities during C0VID-19 outbreak. Delay healthcare by patient with cardiovascular pathologies is a concern as this could lead to preventable morbidity and mortality. It is necessary to implement patient awareness, education, and reassurance initiatives to ensure that impacted patients promptly seek the proper medical attention. It is also important for the health system and public officials to anticipate the indirect effect of a new wave of COVID-19 or a future pandemic on cardiovascular diseases. More research is required to determine whether this indicates a real or fictitious decline in the number of cases of cardiovascular diseases. Abbreviations COVID-19: Corona virus disease 2019 CVD: Cardiovascular diseases NCD: Non communicable diseases Declarations Ethical and administrative authorisation Ethical clearance to carry out our study was gotten from the institutional review board of the faculty of health sciences university of Buea ( 1607-01 ). Administrative approval was gotten from the Southwest Region Delegation of Public health, and the administration of the Buea Regional Hospital. Consent for publication : Not Applicable Data availaibility : The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests: Not applicable Funding: Not applicable Authors' contributions: DA conceptualised and supervised the research project, CN contributed in data analysis and interpretation of results and writing of the manuscript, KK contributed in the writting of the manuscript as well as data analysis, GK data collection, analysis and writing of the manuscript. Acknowledgements : Not applicable Clinical trial number: not applicable. References WHO. The top 10 causes of death. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death.Accessed on the 19 th November 2021. WHO. The impact of the COVID-19 pandemic on noncommunicable disease resources and services: results of a rapid assessment.. World Heal. Organ . 2020. https://www.who.int/publications/i/item/ncds-COVID-rapid-assessment.Accessed on 19 th November 2021. 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Reductions in Heart Failure Hospitalizations During the COVID-19 Pandemic. J Card Fail . 2020;26(6):462-463. McDonnell T, McAuliffe E, Barrett M, Conlon C, Cummins F, Deasy C, Hensey C, Martin C, Nicholson E. CUPID COVID-19: emergency department attendance by paediatric patients during COVID-19 - project protocol. HRB Open Res . 2020 Juin 9;3: 37. Mboera LEG, Akipede GO, Banerjee A, Cuevas LE, Czypionka T, Khan M, Kock R, McCoy D, Mmbaga BT, Misinzo G, et al. Mitigating lockdown challenges in response to COVID-19 in Sub-Saharan Africa. Int J Infect Dis. 2020 juill; 96:308–10. Abia W, Fonchang G, Kaoke M, Fomboh R, Ageh M, Abia E, et al. Interest and perceptions on traditional medicines in Cameroon. Int Res J. 5 Mai. 2015; 2:377–88 Tam CF, Cheung KS, Lam S, Wong A, Yung A, Sze M, Fang J, Tse HF, Siu CW. Impact of coronavirus disease 2019 (COVID-19) outbreak on outcome of myocardial infarction in HongKong, China. Catheter Cardiovasc Interv 2020; De Rosa S, Spaccarotella C, Basso C, Calabro MP, Curcio A, Filardi PP, et al. Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era. Eur Heart J . 2020 07;41(22):2083–8. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5341959","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":374781468,"identity":"a71f21b8-192a-4f81-a2d2-405dba4a4ee9","order_by":0,"name":"Gaetan Kwasseu Konfo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYBACCVRuBQODAQlamIH4DMlaGNuI0CI5I/nxxx8Vh+362/sPfi6cd1jenL35AMOPim04tUhLpJlJ85w5nDzjzGFm6ZnbDhvu7DmWwNhz5jZOLXLSCWbMjG2HkxluJDNI8247zLjhRo4BUASflvTPH3/+O5wsf/8x82/eOYftCWqRls4xkOBtOGxncIOZTRrISCSoRXL+mzJpnmPpCYZnks2sgYzkDWeOJRzE5xeJM8c3f/xRY20vd/zg49s8Nda2G443H3zwowK3FhhIbIDQzWDyAEH1QGAPpeuIUTwKRsEoGAUjDAAAI41bs4I2gRwAAAAASUVORK5CYII=","orcid":"","institution":"University of Buea","correspondingAuthor":true,"prefix":"","firstName":"Gaetan","middleName":"Kwasseu","lastName":"Konfo","suffix":""},{"id":374781472,"identity":"61203c34-3542-4130-8b56-25d38fd8738e","order_by":1,"name":"Clovis Nkoke","email":"","orcid":"","institution":"University of Buea","correspondingAuthor":false,"prefix":"","firstName":"Clovis","middleName":"","lastName":"Nkoke","suffix":""},{"id":374781473,"identity":"4452607f-f538-4222-8fb1-9c5c67d7ebff","order_by":2,"name":"Kenfack Kuaguim","email":"","orcid":"","institution":"University teaching hospital Angré","correspondingAuthor":false,"prefix":"","firstName":"Kenfack","middleName":"","lastName":"Kuaguim","suffix":""},{"id":374781474,"identity":"6fe13536-9084-41fb-baf1-7238c1904268","order_by":3,"name":"Anastase Dzudie","email":"","orcid":"","institution":"University of Yaoundé I","correspondingAuthor":false,"prefix":"","firstName":"Anastase","middleName":"","lastName":"Dzudie","suffix":""}],"badges":[],"createdAt":"2024-10-27 15:23:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5341959/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5341959/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":69911810,"identity":"865f5235-2477-42a3-b575-0210b441edfc","added_by":"auto","created_at":"2024-11-26 13:57:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":50741,"visible":true,"origin":"","legend":"\u003cp\u003eStudy flow-chart\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5341959/v1/89f08164e7e6e1d9295cb2f1.png"},{"id":69911811,"identity":"ef54bf20-1f67-4b43-b000-4f2048277596","added_by":"auto","created_at":"2024-11-26 13:57:35","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":88203,"visible":true,"origin":"","legend":"\u003cp\u003eComparing Trend in Cardiovascular disease admissions before and during COVID-19 pandemic\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5341959/v1/047ed2e8af7fc787321d3a86.png"},{"id":74031098,"identity":"fcd519c2-3e97-4184-91b6-f44f6575d30e","added_by":"auto","created_at":"2025-01-17 06:54:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":824998,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5341959/v1/a3436cfc-b0d6-4e78-9e79-807fbf3a5670.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Trend in Hospital Admissions for Cardiovascular Diseases (CVDs) before and during the Coronavirus Disease 2019 (COVID-19) Pandemic: A Retrospective analysis from a Sub-urban area in sub-Saharan Africa","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eNon communicable diseases (NCDs) contribute about 70% of deaths worldwide with about 80% occurring in low- and middle-income countries [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. NCDs more notably cardiovascular diseases (CVDs) is a leading cause of death and disability globally affecting more cases each year than all other causes combined [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Due to its chronic and sometimes life-long nature, CVDs often require repeated interactions with health systems, and not receiving the care needed often results in devastating consequences for persons living with these conditions [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Since the declaration of the corona virus disease 2019 (COVID-19) pandemic, the trends in NCDs admissions have changed over the world [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This is because despite its direct effect on global health, it also had indirect effects on the morbidity and mortality through changes in behaviours of patients and health care providers in addition to the re-organization of health systems [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The pandemic constitutes a future public health threat as people with NCDs such as CVDs interrupted their treatment, leading to an increased risk of complications due to poor control of their chronic condition. Studies published in western countries showed a reduction in cardiovascular consultations and admissions during the COVID-19 Pandemic [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e][\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e][\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In low- and middle-income countries (LMICs) such as Cameroon, it is likely that with the resource-limited healthcare systems and healthcare inequities, these countries would be poorly equipped to deal with the challenges of the global pandemic. However, data is lacking to confirm this in Africa at large, and Cameroon in particular. The few studies available reported a reduction in the delivery of cardiology services and the majority of services adjusted to the pandemic [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e][\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This is because many patients no longer consult for CVD because of the fear of being infected by COVID-19 in hospitals. Since the declaration of the first case of Covid-19 in Cameroon, there have been an increase rate of new cases, and high mortality rate [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This has mounted fear and doubt in the population, and resulted in people deserting the hospitals [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. With the rising and unmet CVD burden in Cameroon and the rebound of cardiovascular admissions and mortality due to CVDs globally, there is a need to understand its indirect effect on CVDs diseases for both disease burden and health service provision [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This work therefore compared the trend of CVDs before, and during the COVID-19 outbreak in the Southwest region of Cameroon. This will help the policy makers to develop strategies to address thus burden and prepare effectively for any future similar pandemic.\u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003ch2\u003e\u003cstrong\u003eStudy setting and design\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eWe conducted a retrospective study on patients admitted at the Internal Medicine Department of the Buea Regional Hospital (BRH) from March 11 2018 to March 11 2020 (Pre COVID-19 Pandemic), and March 11 2020 to March 11 2022 (During COVID-19 Pandemic). The BRH is a secondary level hospital that serves as the main referral centre for patients suffering for CVDs in the Southwest region of Cameroon. It has a capacity of about 111 beds and a catchment population of about 200, 000 inhabitants. The Internal Medicine Department has a consultant cardiologist, two internists, and general practitioners who manages CVDs using appropriate and standard methods. This facility also serves as a diagnostic and treatment center for patients suffering from the COVID-19 infection. Buea is the Head Quarter of the Southwest region of Cameroon. It is a semi urban setting with main economic activity as agriculture [11]. \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eWe collected data on patients admitted for CVDs at the BRH two years before and after the declaration of COVID-19 as a pandemic in Cameroon. The data collection form designed using Epi info version 7.2.5.0, and was used to extract data from the hospital records of affected patients. After identifying the records of each patient suffering from a CVD, the diagnosis on entry was identified. The progress in the ward, the investigations made and the final diagnosis of CVD made by the specialist on discharge was noted. We included records of patients with the diagnosis of the CVD of interest. We excluded those with no clear diagnosis of CVD in the file. The following data was collected: Sociodemographic data: age, gender, occupation, and comorbidities; Clinical data: final diagnosis of the patient (type of cardiovascular disease and subtype); Outcome: final outcome of the patients (death, full recovery, sequelae, or partial recovery discharge), and duration of hospitalisation. We considered the following CVDs: stroke, heart failure, acute myocardial infarction, uncontrolled hypertension, pericardial disease, arrhythmias, and venous thromboembolism. Patients informations were coded to ensure confidentiality.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eSample size and statistical analysis\u0026nbsp;\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003e\u0026nbsp;A convenient sampling of all eligible participants was considered for this study. The data was analysed using SPSS v25. Continuous variables were presented as mean, standard deviations and graphs, and the Student T-test was used to test for differences between two categories of normally distributed continuous variables. Bivariate analysis was done for categorical variables, and Chi-square test was performed. A P value of \u0026lt;0.05 was considered statistically significant. All reported P-values were based on a two-sided hypothesis.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe mean age of patients admitted with a CVD was 57.97\u0026nbsp;\u0026plusmn; 15.60 years\u0026nbsp;during the\u0026nbsp;Pre-COVID 19 pandemic period compared to 59.74 \u0026plusmn; 16.10 during the COVID 19 pandemic period (p = .442).The number of males during the pandemic was 215(21.5%) compared to 248(24.8%) before while that of females was 268(26.8%) during the pandemic compared to 270(27%) before, giving a male to female ratio during COVID 19 pandemic of 0.9 compared to 0.8 during pre-pandemic period.\u0026nbsp;There was a downward secular trend with random variation of the number of CVDs admissions during the COVID-19 period starting from march 2020 as compared with the corresponding pre-COVID period which had an upward trend (\u003cstrong\u003eFigure 2\u003c/strong\u003e). There was a more drastic drop of admissions in the months of April to June 2020 and from April to August 2021 (\u003cstrong\u003eFigure 2\u003c/strong\u003e). Overall the rate of admissions of stroke decreased by 5.4%, Uncontrolled hypertension by 27.4%, pericarditis 66% and arrhythmias 28.2%, while Heart failure admissions increased by 0.6% and acute MI by 3.4%. (\u003cstrong\u003eTable 1\u003c/strong\u003e). During the first wave of COVID-19 pandemic from march to September 2020, there was a 3% decrease in proportions of stroke, 7.2% decrease in proportion of uncontrolled hypertension, 22.2% decrease in acute MI admissions, and a 4.4% decrease in admissions due to venous thromboembolism compared to the corresponding period before the pandemic. There was also an increase in the proportion of heart failure by 3.5% with 5.2% and 14.3% respective increase in admissions due to arrhythmias, and pericardial disease when compared to the corresponding period pre-COVID period. (\u003cstrong\u003eTable 2\u003c/strong\u003e). The in-hospital mortality rate for patient suffering from CVDs was 15.3% during the pandemic and 12.9% before the COVID-19 pandemic (P=0.446). Patients suffering from heart failure and stroke had the highest mortalities before and during the pandemic. (\u003cstrong\u003eTable 4\u003c/strong\u003e) There was no difference in the median length of hospital stay before and during the COVID-19 pandemic [7 (3-10) days vs 7(4-10) days, (P=0.936)] (\u003cstrong\u003eTable 3\u003c/strong\u003e). \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: \u0026nbsp;Proportions of CVDs \u0026nbsp; before and during Covid-19 Pandemic\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"598\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.0736%;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0502%;\"\u003e\n \u003cp\u003eN(total)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.913%;\"\u003e\n \u003cp\u003ePre-COVID-19 period(march 11 2018-march 11 2020)(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2508%;\"\u003e\n \u003cp\u003eDuring COVID-19 period(march 11 2020-march 11 2022)(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7124%;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.0736%;\"\u003e\n \u003cp\u003eCardiovascular\u003c/p\u003e\n \u003cp\u003edisease\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0502%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.913%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2508%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7124%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.0736%;\"\u003e\n \u003cp\u003eStroke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0502%;\"\u003e\n \u003cp\u003e338(31.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.913%;\"\u003e\n \u003cp\u003e160(47.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2508%;\"\u003e\n \u003cp\u003e178(52.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7124%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.046\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.0736%;\"\u003e\n \u003cp\u003eHeart failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0502%;\"\u003e\n \u003cp\u003e346(32.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.913%;\"\u003e\n \u003cp\u003e174(50.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2508%;\"\u003e\n \u003cp\u003e172(49.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7124%;\"\u003e\n \u003cp\u003e0.502\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.0736%;\"\u003e\n \u003cp\u003eUncontrolled hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0502%;\"\u003e\n \u003cp\u003e234(21.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.913%;\"\u003e\n \u003cp\u003e85(36.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2508%;\"\u003e\n \u003cp\u003e149(63.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7124%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.0736%;\"\u003e\n \u003cp\u003eAcute MI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0502%;\"\u003e\n \u003cp\u003e29(2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.913%;\"\u003e\n \u003cp\u003e15(51.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2508%;\"\u003e\n \u003cp\u003e14(48.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7124%;\"\u003e\n \u003cp\u003e0.998\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.0736%;\"\u003e\n \u003cp\u003ePericardial diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0502%;\"\u003e\n \u003cp\u003e12(1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.913%;\"\u003e\n \u003cp\u003e2(16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2508%;\"\u003e\n \u003cp\u003e10(83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7124%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.014\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.0736%;\"\u003e\n \u003cp\u003eVenous thromboembolism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0502%;\"\u003e\n \u003cp\u003e34(3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.913%;\"\u003e\n \u003cp\u003e17(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2508%;\"\u003e\n \u003cp\u003e17(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7124%;\"\u003e\n \u003cp\u003e0.836\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.0736%;\"\u003e\n \u003cp\u003eArrhythmias\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0502%;\"\u003e\n \u003cp\u003e64(6.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.913%;\"\u003e\n \u003cp\u003e23(35.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2508%;\"\u003e\n \u003cp\u003e41(64.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7124%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.009\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMI: Myocardial infarction\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Proportions of different cardiovascular diseases\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"598\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.9365%;\"\u003e\n \u003cp\u003eCardiovascular disease\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.9264%;\"\u003e\n \u003cp\u003e1\u003csup\u003est\u0026nbsp;\u003c/sup\u003ewave\u003csup\u003e\u0026nbsp;\u003c/sup\u003eCOVID-19 n=159\u003c/p\u003e\n \u003cp\u003eFrequency(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4114%;\"\u003e\n \u003cp\u003eCorresponding period n=168.\u003c/p\u003e\n \u003cp\u003eFrequency(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.7258%;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.9365%;\"\u003e\n \u003cp\u003eStroke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.9264%;\"\u003e\n \u003cp\u003e45(17.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4114%;\"\u003e\n \u003cp\u003e53(20.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.7258%;\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.9365%;\"\u003e\n \u003cp\u003eHeart failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.9264%;\"\u003e\n \u003cp\u003e64(22.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4114%;\"\u003e\n \u003cp\u003e54(19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.7258%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.9365%;\"\u003e\n \u003cp\u003eUncontrolled hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.9264%;\"\u003e\n \u003cp\u003e32(20.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4114%;\"\u003e\n \u003cp\u003e43(28.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.7258%;\"\u003e\n \u003cp\u003e0.175\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.9365%;\"\u003e\n \u003cp\u003eAcute MI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.9264%;\"\u003e\n \u003cp\u003e1(5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4114%;\"\u003e\n \u003cp\u003e5(27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.7258%;\"\u003e\n \u003cp\u003e0.607\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.9365%;\"\u003e\n \u003cp\u003ePericardial disease\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.9264%;\"\u003e\n \u003cp\u003e3(21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4114%;\"\u003e\n \u003cp\u003e1(7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.7258%;\"\u003e\n \u003cp\u003e0.521\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.9365%;\"\u003e\n \u003cp\u003eVenous thromboembolism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.9264%;\"\u003e\n \u003cp\u003e3(13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4114%;\"\u003e\n \u003cp\u003e4(17.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.7258%;\"\u003e\n \u003cp\u003e0.648\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.9365%;\"\u003e\n \u003cp\u003eArrhythmias\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.9264%;\"\u003e\n \u003cp\u003e11(19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4114%;\"\u003e\n \u003cp\u003e8(13.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.7258%;\"\u003e\n \u003cp\u003e0.396\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMI: myocardial infarction, n=total number of admissions, 1\u003csup\u003est\u003c/sup\u003e wave of COVID-19 in Cameroon: March 2020 to September 2020\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Outcome of cardiovascular diseases\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"686\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eOutcome, n (%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003en=1001\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFrequency(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003ePre-COVID 19 period\u003c/p\u003e\n \u003cp\u003en=518\u003c/p\u003e\n \u003cp\u003eFrequency(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eDuring COVID-19 period\u003c/p\u003e\n \u003cp\u003en=483\u003c/p\u003e\n \u003cp\u003eFrequency(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eAlive/Discharged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e857(85.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e450(86.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e407(84.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.446\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eDeath\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e141(14.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e67(12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e74(15.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eTransfer to other facilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e3(0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e1(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e2(0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eMedian length of hospital stay in days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e7.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e7.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;7.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.936\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eInterquartile range of length of hospital stay in days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e4-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e3-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp; 4-10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003en=total number of admissions\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Mortality due to different CVDs\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"599\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.7145%;\"\u003e\n \u003cp\u003eCardiovascular disease\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7078%;\"\u003e\n \u003cp\u003eIn-hospital mortality before COVID\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8731%;\"\u003e\n \u003cp\u003eIn-hospital mortality during COVID N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.7045%;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.7145%;\"\u003e\n \u003cp\u003eStroke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7078%;\"\u003e\n \u003cp\u003e25(15.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8731%;\"\u003e\n \u003cp\u003e28(15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.7045%;\"\u003e\n \u003cp\u003e0.222\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.7145%;\"\u003e\n \u003cp\u003eHeart failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7078%;\"\u003e\n \u003cp\u003e28(16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8731%;\"\u003e\n \u003cp\u003e31(18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.7045%;\"\u003e\n \u003cp\u003e0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.7145%;\"\u003e\n \u003cp\u003eUncontrolled hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7078%;\"\u003e\n \u003cp\u003e9(6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8731%;\"\u003e\n \u003cp\u003e4(4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.7045%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.7145%;\"\u003e\n \u003cp\u003eAcute MI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7078%;\"\u003e\n \u003cp\u003e1(6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8731%;\"\u003e\n \u003cp\u003e3(21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.7045%;\"\u003e\n \u003cp\u003e0.463\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.7145%;\"\u003e\n \u003cp\u003ePericardial disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7078%;\"\u003e\n \u003cp\u003e1(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8731%;\"\u003e\n \u003cp\u003e3(30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.7045%;\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.7145%;\"\u003e\n \u003cp\u003eVenous thromboembolism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7078%;\"\u003e\n \u003cp\u003e4(23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8731%;\"\u003e\n \u003cp\u003e4(23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.7045%;\"\u003e\n \u003cp\u003e0.186\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.7145%;\"\u003e\n \u003cp\u003eArrhythmias\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7078%;\"\u003e\n \u003cp\u003e4(17.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8731%;\"\u003e\n \u003cp\u003e7(17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.7045%;\"\u003e\n \u003cp\u003e0.515\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMI myocardial infarction\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study demonstrates a reduction in Hospital Admissions for CVDs during the COVID-19 in an internal medicine service of a sub urban city of Cameroon. Three major findings must be outlined. 1) No significant difference in the mean age at admission and male to female ratio before and during the pandemic. 2) a falling trend of CVD admissions during COVID-19 period, with a more drastic drop of admissions in the months of April to June 2020 and from April to August 2021. 3) The overall in-hospital mortality of patients with CVDs had an increasing tendency during the pandemic, but there was no change in median length of hospital stay during the two periods. Patients suffering from heart failure and stroke had the highest mortalities before and during the pandemic. The COVID 19 pandemic constitutes a future public health threat as people with chronic NCDs interrupt their treatment, leading to an increased risk of complications due to poor control of their chronic condition. The goal of our study was to evaluate the trend in CVD admission and outcome before and during the COVID-19 pandemic at the Buea Regional Hospital. This will help the Ministry of Health and other policy makers to take better decisions and strategies in order to improve CVD outcomes in case of other waves of the COVID-19 pandemics and future pandemics if need arises.\u003c/p\u003e \u003cp\u003ePhysicians expressed grave concern regarding the potential rise in cardiovascular patients in hospitals as a result of presentations that were either stable or previously undetected throughout the epidemic. Furthermore, as a result of this crisis, there may be an increase in patients experiencing delayed consequences from ACS and reinfarctions in the near future. [ 7]\u003c/p\u003e \u003cp\u003eThe falling trend of CVDs admissions starting from March to June 2020 in Cameroon, can be explained by several factors, the fear of contracting COVID-19 virus which is known to be highly contagious by the population and thus most patients preferred to stay away from hospitals [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Also this reduction could be due to the fact that some patients were scared that in the event of death they will be buried immediately without them receiving proper last respect from their family members and loved ones [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This is because in Africa, mourning of the deceased is considered very important and the way it is approached is different from that in the western countries[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].This period also coincide with the time when the government implemented 19 measures during lockdown in order to limit the spread of the virus including restricting access to public spaces[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].Also, with the advent of Covid-19 vaccine, patients were scared and anxious in getting the vaccine and so preferred to avoid going to the hospitals. This might have contributed to the reduction of people seeking for healthcare during this period. Health care reconfiguration of both primary and secondary care by sudden cessation of routine-face to face appointments, interruption of established care pathways and reduced availability of medical staffs has also contributed to the reductions in cardiovascular diseases consultations[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]These findings are similar to those in a study carried out in Brazil by Normando PG et al which showed a 15% drop in admissions of cardiovascular disease during COVID-19 pandemic[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].Also a crossectional e-survey conducted among cardiologist in Africa by Chris Nadege Nganou et al showed a reduction in the number of consultations due to cardiovascular diseases during COVID-19 in Africa [ 9]. This decrease is also demonstrated in other disciplines as evident by a decrease in paediatric admissions during COVID-19 outbreak in Cameroon [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].The drop in the proportion of stroke (3%), uncontrolled hypertension (7.2%), MI (22.2%) and venous thromboembolism(4.4%) during the first wave of the pandemic, might be due to the fact that this was the early phase of the pandemic little was known about the disease at this time and the fear of contracting the disease by the population was at its peak during this period [ 13,17].This result is similar to that obtained in Qatar by Akhtar N et al which showed a decrease in admissions due to stroke from 87 to 34 per month during the early phase COVID-91 pandemic.[ 18] The increase in proportion of heart failure 3.5%, arrhythmias 5.2% ,and pericardial disease 14.3% during the first wave might be due the fact that this period coincides with the lockdown period which was associated with increased risk of cardiovascular disease by promoting an increases in unhealthy eating habits, decreases in physical activity and stress[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], An increase in tobacco usage was also noted in Italy, India, South Africa, the UK, and the USA during the COVID-19 lockdown[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].However, this result contradict that of Hall ME et al who showed a considerable decrease in the admissions due to heart failure from march to April 2020 [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].The overall increase in in-hospital mortality as shown in our study may be explained by the fact that patients delayed in seeking medical care and thus being hospitalized in more severe conditions. [ 16] Delay in seeking medical care during this period was noted in many hospitals over the world including developed countries [ 26] and this might have occurred due to different reasons that is financial difficulties or the use of alternative traditional medicines in our case [ 19,27, 28]. Also Increase in cardiovascular risk factors such as physical inactivity, improper eating habit, tobacco usage and alcohol misusage may have increased the rate of CVD related premature deaths during this period [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], this result is similar to that in a study carried out in Italy by De Rosa S et al which showed an increase in the case fatality rate of acute MI during the pandemic. [29, 30], Another study carried out in Cameroon on paediatric admissions by Chelo D et al showed a doubling of the mortality rate in children during COVID-outbreak compared to before [ 9].\u003c/p\u003e\n\u003ch3\u003eSTRENGTH AND LIMITATIONS\u003c/h3\u003e\n\u003cp\u003eOur study's unique methodological strengths, which guarantee its validity and facilitate the interpretation of data, are as follows: (i) comparisons were done between the relevant periods of the pandemic such as during the first wave with the corresponding Periods. However, Patients with severe cardiovascular diseases might have died home even before reaching the hospital and so this study may have underestimated the occurrence of cardiovascular diseases as they will not be registered in the hospital registries. This study provides valuable information on the epidemiology of cardiovascular diseases before and during the Covid-19 pandemic.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study shows a falling Trend in the number of admissions due to cardiovascular disease during the COVID-19 Pandemic at the BRH, with an increase in mortality due to cardiovascular diseases during the pandemic. This data supports the fact that health care utilization might have reduced during the Pandemic and this may be due to patients fear of medical facilities during C0VID-19 outbreak. Delay healthcare by patient with cardiovascular pathologies is a concern as this could lead to preventable morbidity and mortality. It is necessary to implement patient awareness, education, and reassurance initiatives to ensure that impacted patients promptly seek the proper medical attention. It is also important for the health system and public officials to anticipate the indirect effect of a new wave of COVID-19 or a future pandemic on cardiovascular diseases. More research is required to determine whether this indicates a real or fictitious decline in the number of cases of cardiovascular diseases.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCOVID-19: Corona virus disease 2019\u003c/p\u003e\n\u003cp\u003eCVD: Cardiovascular diseases\u003c/p\u003e\n\u003cp\u003eNCD: Non communicable diseases\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical and administrative authorisation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance to carry out our study was gotten from the institutional review board of the faculty of health sciences university of Buea (\u003cstrong\u003e1607-01\u003c/strong\u003e). Administrative approval was gotten from the Southwest Region Delegation of Public health, and the administration of the Buea Regional Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e : Not Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availaibility\u003c/strong\u003e : The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e DA conceptualised and supervised \u0026nbsp;the research project, CN contributed in data analysis and interpretation of results and writing of the manuscript, KK contributed in the writting of the manuscript \u0026nbsp; as well as data analysis, GK data collection, analysis and writing of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e : Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWHO. 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Decrease in Hospitalizations and Increase in Deaths during the COVID-19 Epidemic in a\u003cem\u003e\u0026nbsp;\u003c/em\u003ePediatric Hospital, Yaounde-Cameroon and Prediction for the Coming Months\u003cem\u003e. Fetal Pediatr Pathol\u003c/em\u003e ; 2021;40:18\u0026ndash;31.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCoronavirus disease (COVID-19). question-and-answers-hub: Schools . https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/coronavirus-disease-COVID-19-schools.Accessed on the 19\u003csup\u003eth\u003c/sup\u003e November 2021.\u003c/li\u003e\n \u003cli\u003eNkoke C, Jingi AM, Makoge C, Teuwafeu D, Nkouonlack C, Dzudie A. Epidemiology of cardiovascular diseases related admissions in a referral hospital in the South West region o\u003cem\u003ef\u0026nbsp;\u003c/em\u003eCameroo\u003cem\u003en:\u003c/em\u003e A cross-sectional study in sub-Saharan Africa. \u003cem\u003ePLoS One\u003c/em\u003e. 2019;14:1\u0026ndash;8.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTemgoua M, Endomba FT, Mfeukeu Kuate L, Tochie JN, Ngatchou W. Potential relationship between mental health during the COVID-1 9 crisis and cardiovascular diseases: time to break the vicious cycle.\u0026nbsp;https://preprints.jmir.org/preprint/20807\u003c/li\u003e\n \u003cli\u003eEkore R, Lanre-Abass B. African cultural concept of death and the idea of advance care directives.Indian Journal of Palliative Care. 201 6;22(4):369.\u003c/li\u003e\n \u003cli\u003eEsso L, Ep\u0026eacute;e E, Bilounga C, et al.\u0026nbsp;Cameroon\u0026apos;s bold response to the COVID-19 pandemic during the first and second waves. \u003cem\u003eLancet Infect Dis\u003c/em\u003e. 2021;21(8):1064-1065. doi:10.1016/S1473-3099(21)00388-1.\u003c/li\u003e\n \u003cli\u003eAntonio Cannata` 1,2*, Daniel I. Bromage 1,2, and Theresa A. McDonagh, The collateral cardiovascular damage of COVID-19: only history will reveal the depth of the iceberg; \u003cem\u003eEuropean Heart Journal\u003c/em\u003e (2021) 42, 1524\u0026ndash;1527.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eNormando PG, Araujo-Filho JA, Fonseca GA, et al.\u0026nbsp;Reduction in Hospitalization and Increase in Mortality Due to Cardiovascular Diseases during the COVID-19 Pandemic in Brazil.. \u003cem\u003eArq Bras Cardiol\u003c/em\u003e. 2021;116(3):371-380.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBang, H. (2020). An Overview of the COVID-19 Crisis Management in Cameroon: Decentralised Governance Response Needed. \u003cem\u003eAnnals of Disaster Risk Sciences\u003c/em\u003e, \u003cem\u003e3\u003c/em\u003e(2).\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAkhtar N, Al Jerdi S, Mahfoud Z, Imam Y, Kamran S, Saqqur M, Morgan D, Joseph S, Khan K, Shuaib A. Impact of COVID-19 pandemic on stroke admissions in Qatar. \u003cem\u003eBMJ Neurology Open\u003c/em\u003e. 2021;3(1).\u003c/li\u003e\n \u003cli\u003eZhang Y, Geng X, Tan Y, Li Q, Xu C, Xu J (2020) New understanding of the damage of SARS-CoV-2 infection outside the respiratory system. \u003cem\u003eBiomedicine \u0026amp; Pharmacology.\u003c/em\u003e2020; 127.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCharansonney O, L. Physical activity and aging: a lifelong story. \u003cem\u003eDiscovery Medicine.\u0026nbsp;\u003c/em\u003e2011;\u0026nbsp;12:177\u0026ndash;185.\u003c/li\u003e\n \u003cli\u003eClay JM, Parker MO. Alcohol use and misuse during COVID-19 pandemic. A potential public health crisis? \u003cem\u003eLancet Public Health.\u0026nbsp;\u003c/em\u003e2020;\u0026nbsp;5:259.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKim JUN et al Effect of COVID-19 lockdown on alcohol consumption in patient with pre-existing alcohol use disorders. \u003cem\u003eLancet Gastroenterol. Hepatol\u003c/em\u003e. 2020;2468-1253(20).\u003c/li\u003e\n \u003cli\u003eYach D Tobacco use pattern in five countries during the COVID-19 lockdown. \u003cem\u003eNicotine and Tobacco Research\u003c/em\u003e.:2020;1671\u0026ndash;1672.\u003c/li\u003e\n \u003cli\u003eHolshue M, \u0026nbsp;DeBolt C, Lindquist S, Lind KH, Wiesman J, Bruce H et al.Investigation Team first case of 2019 novel Coronavirus in the united states, \u003cem\u003eN Engl J Med\u003c/em\u003e 2020;382:929\u0026ndash;36.\u003c/li\u003e\n \u003cli\u003eHall ME, Vaduganathan M, Khan MS, et al. Reductions in Heart Failure Hospitalizations During the COVID-19 Pandemic. \u003cem\u003eJ Card Fail\u003c/em\u003e. 2020;26(6):462-463.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMcDonnell T, McAuliffe E, Barrett M, Conlon C, Cummins F, Deasy C, Hensey C,\u003cbr\u003e\u0026nbsp;Martin C, Nicholson E. CUPID COVID-19: emergency department attendance by paediatric patients during COVID-19 - project protocol.\u0026nbsp;\u003cem\u003eHRB Open Res\u003c/em\u003e. 2020 Juin 9;3: 37.\u003c/li\u003e\n \u003cli\u003eMboera LEG, Akipede GO, Banerjee A, Cuevas LE, Czypionka T, Khan M, Kock R,\u003cbr\u003e\u0026nbsp;McCoy D, Mmbaga BT, Misinzo G, et al.\u0026nbsp;Mitigating lockdown challenges in response to COVID-19 in Sub-Saharan Africa. Int J Infect Dis. 2020 juill; 96:308\u0026ndash;10.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAbia W, Fonchang G, Kaoke M, Fomboh R, Ageh M, Abia E, et al. Interest and perceptions on traditional medicines in Cameroon. Int Res J. 5 Mai. 2015; 2:377\u0026ndash;88\u003c/li\u003e\n \u003cli\u003eTam CF, Cheung KS, Lam S, Wong A, Yung A, Sze M, Fang J, Tse HF, Siu CW.\u003cbr\u003eImpact of coronavirus disease 2019 (COVID-19) outbreak on outcome of myocardial infarction in HongKong, China. \u003cem\u003eCatheter Cardiovasc Interv\u003c/em\u003e 2020;\u003c/li\u003e\n \u003cli\u003eDe Rosa S, Spaccarotella C, Basso C, Calabro MP, Curcio A, Filardi PP, et\u003cbr\u003e\u0026nbsp;al. Reduction of hospitalizations for myocardial infarction in Italy in the\u003cbr\u003eCOVID-19 era. \u003cem\u003eEur Heart J\u003c/em\u003e. 2020 07;41(22):2083\u0026ndash;8.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-5341959/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5341959/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe COVID-19 pandemic was a global public concern and constitute a future threat to the world population due to its indirect effect on the burden of non-communicable diseases. The pandemic manifested disruptions in health care delivery and access. However, there is limited data in Sub-Saharan Africa on the impact of the COVID-19 on cardiovascular disease (CVD) admissions and outcomes.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eTo compare the trends of CVD admissions and outcome before and during the COVID-19 pandemic in the Southwest Region of Cameroon.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe carried out a retrospective study of patients suffering from CVDs admitted from March 11 2018 to March 11 2020 (Pre-COVID-19 pandemic period) and from March 11 2020 to March 11 2022 (COVID-19 pandemic period). A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere were 483 admissions due to CVDs during the COVID-19 pandemic period and 518 during the pre-COVID-19 period. There was no significant difference in mean age before (57.97\u0026thinsp;\u0026plusmn;\u0026thinsp;15.6 years) and during the pandemic (59.74\u0026thinsp;\u0026plusmn;\u0026thinsp;16.1years) (P\u0026thinsp;=\u0026thinsp;0.44).There was also no significant change in the proportion of males and females during and before the pandemic: males (21, 4% and 24.8%), and females (26.8% and 27%), (P\u0026thinsp;=\u0026thinsp;0.28). There was a downward secular trend with random variation of the number of CVDs admissions during the COVID-19 period when compared with the corresponding pre-COVID period which had an upward trend. Rates of admissions of Acute Myocardial infarction decreased the most (22.2%), and pericardial disease increased the most (14.3%) during the first wave of the pandemic. The in-hospital mortality increased by 2.4% and there was no change in median length of hospital stay (p\u0026thinsp;=\u0026thinsp;0.936).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study provides evidence of a decreasing tendency in admissions due to CVDs during COVID-19 Pandemic at the BRH, and its effects varied among the different types of CVDs. The in-hospital mortality of CVDs increased during the pandemic.\u003c/p\u003e","manuscriptTitle":"Trend in Hospital Admissions for Cardiovascular Diseases (CVDs) before and during the Coronavirus Disease 2019 (COVID-19) Pandemic: A Retrospective analysis from a Sub-urban area in sub-Saharan Africa","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-26 13:57:31","doi":"10.21203/rs.3.rs-5341959/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cd12f484-c3c7-4983-9d3a-78f3077eb2c3","owner":[],"postedDate":"November 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-17T06:53:24+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-26 13:57:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5341959","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5341959","identity":"rs-5341959","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}