Clinical Presentation, Risk Factors, and Outcomes of Cardiovascular Disease in a Military Cardiac Center in Yemen
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Background
Cardiovascular diseases (CVDs) are a growing public health concern in Yemen, yet detailed data from local facilities are limited. This study aimed to evaluate clinical characteristics, risk factors, and outcomes of CVDs in a military cardiac center.
Aim
To evaluate the clinical characteristics, risk factors, and outcomes of cardiovascular diseases (CVDs) among patients admitted to the Coronary Care Unit (CCU).
Setting
The study was conducted at the Military Cardiac Center in Sana’a, which includes a 7-bed CCU for cardiac cases, 75 general ward beds, 4 beds in the emergency department, and 2 beds in the operating theater.
Methods
A retrospective cohort study was conducted at the Military Cardiac Center in Sana’a, including all patients admitted to the Coronary Care Unit (CCU) in 2019. Clinical data were extracted from both electronic and archived paper records, including prior medical histories dating back to 2008 or 2010 when available. Variables included demographics, clinical presentations, diagnoses, prior cardiac history, and outcomes. Statistical analyses were performed using descriptive statistics, chi-square tests, ANOVA, and univariate logistic regression to identify predictors of in-hospital and 5-year mortality.
Results
A total of 446 patients were included (mean age:53.0 plus/minus 13.6 years; 84% male). The most common diagnoses were acute coronary syndrome (ACS, 60.9%), acute decompensated heart failure (ADHF, 13%), valvular heart disease (VHD, 9%), and cardiogenic shock (5%). Risk factors included khat use (76%), smoking (61%), hypertension (41%), diabetes (31%), and dyslipidemia (4.9%). Younger patients had higher rates of smoking, khat use, and prior myocardial infarction or PCI, while older patients had more diabetes, hypertension, and dyslipidemia. Significant predictors of in-hospital mortality included diabetes (OR=2.6), rheumatic heart disease (RHD, OR=2.4), cardiogenic shock (OR=11.3), heart failure (OR=9.2), sepsis (OR=31.1), and cardiac arrest (OR=74.0). For 5-year mortality, key predictors were unstable angina (OR=8.7), ACS (OR=4.0), elective PCI (OR=2.9), and khat use (OR=2.0).
Conclusion
CVDs in Yemen affect relatively young patients and are driven by modifiable, region-specific risk factors. Limited access to emergency interventions and late hospital presentation contribute to poor outcomes. Public awareness, preventive measures, and improved cardiac care infrastructure are urgently needed.
Recommendations
Enhancing public awareness, expanding access to cardiac emergency care, and strengthening preventive services are crucial to reducing mortality and improving outcomes. Implementing these measures urgently can substantially mitigate the burden of cardiovascular disease in Yemen.
