Many pharmacological agents are usually combined to manage inflammation, haemodynamic and neuroho... more Many pharmacological agents are usually combined to manage inflammation, haemodynamic and neurohormonal alterations which occur in patients with cardiovascular diseases (CVDs). Combination therapy usually results in undesired drug-drug interactions (DDIs) and adverse drug reactions (ADRs). The aim of this study was to determine the various DDIs and ADRs that occurred in patients with CVDs receiving pharmacological treatment at the cardiac clinic, Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Two hundred and forty-eight (248) patients were recruited for the study. Eligible participants were patients with heart failure, ischaemic heart disease or arrhythmias aged 13 years and above. ADR report involved documentation of adverse effects to previous cardiovascular therapy. ADRs were categorized based on the type of ADR, organ or system implicated, suspected medicine (s) that induced the effect and intervention provided to avert the problem. All medications prescribed during routine visit were also documented to assess for DDI. The prescription per patient were entered into an online medical information source (Medscape) to generate the interactions. The interactions were compared to Stockley’s drug interaction, 9th edition (2010) and British National Formulary, 66 th edition (2013/2014). A total of 19 ADRs were reported in 17 patients, that is 6.9% of the sample. The proportion of these ADRs were 17.6%, 35.3% and 49.1% for age ranges 30-49, 50-69 and 70-89 years with the average age of 65.2 years. More men reported ADRs with the ratio of men to women being 0.59:0.41. Aspirin recorded the highest percentage drug interactions (21.3%, n=43), followed by furosemide (11.4%, n=23) and bisoprolol (12.4%, n=25). Out of the 202 interactions, 152 (75.2%) of the interactions were significant whereas 37 (18.3%) and 13 (6.4%) were mild and severe respectively. Again, 122 (60.4%) of the interactions were pharmacodynamic interactions whereas 72 (35.6%) of interactions were pharmacokinetic interactions. The mechanisms of the remaining 8 (4.0%) interactions were unknown. CONCLUSION: ADRs and DDIs occurred in patients with cardiovascular diseases receiving pharmacological treatment. Respiratory, gastrointestinal and central nervous systems were the commonest systems affected by ADRs. Manifestation of ADR was directly related to the number of co-morbidities and age of patients.
Thyrotoxic periodic paralysis (TPP) is an uncommon symmetrical paralysis usually affecting proxim... more Thyrotoxic periodic paralysis (TPP) is an uncommon symmetrical paralysis usually affecting proximal muscles, which occurs in the hyperthyroid state with associated hypokalemia. It is more prevalent in East Asian males and extremely rare in blacks. Data on TPP is scarce in Africa and no report has been made in Ghana. We report a case of a middle-aged Ghanaian man who had three episodes of paralysis in all four limbs occurring at night with the second and third episodes requiring hospital visit. He had no clinical signs of hyperthyroidism during his first hospital visit but had developed clinical and biochemical evidence of hyperthyroidism on the second visit with serum potassium levels of 1.9 mmol/l; and he was eventually diagnosed with TPP. His paralysis resolved with correction of the hypokalemia. It is important to evaluate patients presenting with paralysis comprehensively. Less common differential diagnosis such as TPP may also be considered in such patients to ensure early diag...
Background: Logistic and socioeconomic barriers limit effective blood pressure (BP) control in ma... more Background: Logistic and socioeconomic barriers limit effective blood pressure (BP) control in many parts of Sub-Saharan Africa, including the Republic of Ghana. We tested a novel hypertension management model of care designed for resource-limited settings. Methods and Results: The “Akoma Pa” model was developed using human-centered design methodology involving patients, physicians, and nurses. The model consisted of a mobile tablet, BP machine and a novel software application in a unique platform to allow for longitudinal patient management. Patients were provided with a tailored hypertension management plan based on their enrollment comorbidities and risk factors. A cohort of 150 hypertensive patients (57±8 years; 73% female) accessed regular blood pressure assessments at a local pharmacy and received real-time automated feedback based on their individualized plan. On the mobile application, clinicians were able to view patient data, provide patients with feedback via SMS on their...
Atrial Septal Aneurysm (ASA) can be congenital or acquired, and rarely reported in sub-Saharan Af... more Atrial Septal Aneurysm (ASA) can be congenital or acquired, and rarely reported in sub-Saharan African population. A number of studies have reported an association between ASA and cardiac arrhythmias; few studies have reported on association of ASA and cardiac conduction abnormalities. We report a case of ASA and intermittent atrio-ventricular (AV) block were detected on echocardiography and 24-hour ambulatory electrocardiography in a 65-year-old woman who presented with recurrent palpitations. This case report shows that ASA may not be as rare in sub-Saharan African populations as it is thought. More echocardiographic studies on ASA are needed to understand the prevalence and the impact of ASA in these populations.
Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine, 2020
Background: There is a dearth of publications on the prevalence of venous thromboembolism in Ghan... more Background: There is a dearth of publications on the prevalence of venous thromboembolism in Ghana. Knowledge of the prevalence of venous thromboembolism, which is often undetected clinically, will help save lives as appropriate interventions can be made as well as provide a general clue to clinicians on detecting venous thromboembolism and pulmonary embolism. Methods: The study employs a retrospective design with data extracted from the Autopsy Daybook of the Pathology unit, Komfo Anokye Teaching Hospital, 2009 to 2016. Data on patients’ demographics were retrieved to establish diagnoses and age and gender distribution. Analysis was made of pulmonary embolism and deep vein thrombosis as a cause of death recorded on death certificates using the criteria of the International Classification of Diseases, version 10. Results: A total of 150 cases of deep vein thrombosis and/or pulmonary embolism were available for the study period and the results showed an average age of 45.3 years with...
BackgroundSub-Saharan Africa (SSA) has the highest prevalence of cardiovascular diseases (CVD). N... more BackgroundSub-Saharan Africa (SSA) has the highest prevalence of cardiovascular diseases (CVD). Nevertheless, very few studies have directly examined the development of and risk factors for CVD among Africans.ObjectiveTo examine CVD risk factors and outcomes particularly in the early stage of CVD development among adults in Ghana.MethodsUsing a stratified multistage random sampling method, 1,106 participants were recruited as a nationally representative sample of the general population ≥18 years in Ghana from 2016 to 2017. For each participant, we measured CVD risk factors and preclinical target organ damage (TOD) for CVD development.ResultsThe prevalence of CVD risk factors was 21.1% for obesity, 10.8% for diabetes, 55.4% for hypertension, 37.3% for dyslipidemia, 12.8% for hyperuricemia, and 39.3% for hsCRP>3 mg/L in the recruited population. The prevalence of preclinical TOD was 8.6% for peripheral artery disease (PAD), 14.7% for carotid thickening, 5.9% for left ventricular hy...
Objective: A novel locally appropriate hypertension management model of care was developed and te... more Objective: A novel locally appropriate hypertension management model of care was developed and tested in the Republic of Ghana to address specific socioeconomic and community-related barriers to blood pressure (BP) control. Design and Methods: Patients with a history of hypertension were enrolled and each agreed to visit a participating nearby community pharmacy at least once per week for 6 months for a BP check, symptom review, and medication monitoring. Weekly pharmacy visit data were manually logged into a mobile application by the pharmacy staff. Guideline based logic in the application provided immediate feedback to the patient and transmitted data to the primary physician. Electronic prescriptions, from the primary physician, were accessible to participating pharmacies. Clinic blood pressure from the prior 6 months was also retrieved from patient records. Results: Compliance with weekly BP assessments in the 150 enrolled patients (57± 8 years; 73% Female) was 61% and 2705 tota...
Prevalence of cardiovascular disease in Africa has increased in recent years. Studies suggest tha... more Prevalence of cardiovascular disease in Africa has increased in recent years. Studies suggest that cardiovascular disease will soon be the most important cause of morbidity and mortality in Africa. The objective of this study was to determine the prevalence of cardiovascular risk factors in patients presenting to the cardiac clinic of the Department of Medicine, Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Medical records of 432 patients were selected from the cardiac clinic, using simple random sampling. The demographic characteristics of the patients together with the prevalence of cardiovascular disease risk factors were examined. The patients were aged between 13 - 97 years with the mean age (+/-standard deviation) of 55.35 (+/-19) years. There were more females 229 (53 %) than males 203 (47 %). The main cardiovascular risk factors seen included: hypertension (48.4 %), overweight and obesity (46.3 %), dyslipidaemia (43 %), Electrocardiographic left ventricular hypertrop...
The estimated rate of sudden cardiac death (SCD) in Western countries ranges from 300,000 to 400,... more The estimated rate of sudden cardiac death (SCD) in Western countries ranges from 300,000 to 400,000 annually, which represents 0.36 to 1.28 per 1 000 inhabitants in Europe and the United States. The burden of SCD in Africa is unknown. Our aim is to assess the epidemiology of SCD in Africa. The Pan-Africa SCD study is a prospective, multicentre, community-based registry monitoring all cases of cardiac arrest occurring in victims over 15 years old. We will use the definition of SCD as 'witnessed natural death occurring within one hour of the onset of symptoms' or 'unwitnessed natural death within 24 hours of the onset of symptoms'. After approval from institutional boards, we will record demographic, clinical, electrocardiographic and biological variables of SCD victims (including survivors of cardiac arrest) in several African cities. All deaths occurring in residents of districts of interest will be checked for past medical history, circumstances of death, and autopsy report (if possible). We will also analyse the employment of resuscitation attempts during the time frame of sudden cardiac arrest (SCA) in various patient populations throughout African countries. This study will provide comprehensive, contemporary data on the epidemiology of SCD in Africa and will help in the development of strategies to prevent and manage cardiac arrest in this region of the world.
The surge in prevalence of chronic noncommunicable diseases like hypertension and chronic kidney ... more The surge in prevalence of chronic noncommunicable diseases like hypertension and chronic kidney disease has been linked with modifiable lifestyle practices and increased body fat. This study sought to compare the association between different modifiable lifestyle practices, adiposity indices, renal function parameters, and hypertension as well as the predictive implications for levels of these parameters in target cardiac organ damage among an urban Ghanaian hypertensive population. Using a hospital-based case-control study design, 241 Ghanaian indigenes from the Kumasi metropolis were recruited for this study. The case group was made up of 180 hypertensives and 61 normotensives served as controls. In addition to sociodemographic data, standard haemodynamic, anthropometric, renal function, and cardiac organ damage assessments were done. The prevalence of chronic kidney disease (CKD) ranged from 13.3% to 16.6% depending on the equation used in estimating the glomerular filtration ra...
Background: Cardiovascular disease (CVD) is a major cause of morbidity and hypertension is the si... more Background: Cardiovascular disease (CVD) is a major cause of morbidity and hypertension is the single most important modifiable risk. Assessment of an individual’s “total” predicted risk of developing a CVD event in 5- or 10-years using risk scores has been identified as an accurate measure of CVD risk. Using the latest Framingham risk score we assessed the risk among patients attending two cardiac clinics in Kumasi.Methods: We conducted a hospital-based cross-sectional study among 441 patients attending two cardiac clinics in Kumasi, the Ashanti region of Ghana. Hospital records were reviewed and information on demography, social history and laboratory results for the lipid profile tests were extracted.Results: The prevalence of low, medium and high risk were 41.5%, 28.1% and 30.4% respectively. More men were at high risk compared to females (36.0% vs 23.9%, p=0.003). The risk score showed good discrimination for cardiovascular risk stratification with an overall area under the cur...
Many pharmacological agents are usually combined to manage inflammation, haemodynamic and neuroho... more Many pharmacological agents are usually combined to manage inflammation, haemodynamic and neurohormonal alterations which occur in patients with cardiovascular diseases (CVDs). Combination therapy usually results in undesired drug-drug interactions (DDIs) and adverse drug reactions (ADRs). The aim of this study was to determine the various DDIs and ADRs that occurred in patients with CVDs receiving pharmacological treatment at the cardiac clinic, Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Two hundred and forty-eight (248) patients were recruited for the study. Eligible participants were patients with heart failure, ischaemic heart disease or arrhythmias aged 13 years and above. ADR report involved documentation of adverse effects to previous cardiovascular therapy. ADRs were categorized based on the type of ADR, organ or system implicated, suspected medicine (s) that induced the effect and intervention provided to avert the problem. All medications prescribed during routine visit were also documented to assess for DDI. The prescription per patient were entered into an online medical information source (Medscape) to generate the interactions. The interactions were compared to Stockley’s drug interaction, 9th edition (2010) and British National Formulary, 66 th edition (2013/2014). A total of 19 ADRs were reported in 17 patients, that is 6.9% of the sample. The proportion of these ADRs were 17.6%, 35.3% and 49.1% for age ranges 30-49, 50-69 and 70-89 years with the average age of 65.2 years. More men reported ADRs with the ratio of men to women being 0.59:0.41. Aspirin recorded the highest percentage drug interactions (21.3%, n=43), followed by furosemide (11.4%, n=23) and bisoprolol (12.4%, n=25). Out of the 202 interactions, 152 (75.2%) of the interactions were significant whereas 37 (18.3%) and 13 (6.4%) were mild and severe respectively. Again, 122 (60.4%) of the interactions were pharmacodynamic interactions whereas 72 (35.6%) of interactions were pharmacokinetic interactions. The mechanisms of the remaining 8 (4.0%) interactions were unknown. CONCLUSION: ADRs and DDIs occurred in patients with cardiovascular diseases receiving pharmacological treatment. Respiratory, gastrointestinal and central nervous systems were the commonest systems affected by ADRs. Manifestation of ADR was directly related to the number of co-morbidities and age of patients.
Thyrotoxic periodic paralysis (TPP) is an uncommon symmetrical paralysis usually affecting proxim... more Thyrotoxic periodic paralysis (TPP) is an uncommon symmetrical paralysis usually affecting proximal muscles, which occurs in the hyperthyroid state with associated hypokalemia. It is more prevalent in East Asian males and extremely rare in blacks. Data on TPP is scarce in Africa and no report has been made in Ghana. We report a case of a middle-aged Ghanaian man who had three episodes of paralysis in all four limbs occurring at night with the second and third episodes requiring hospital visit. He had no clinical signs of hyperthyroidism during his first hospital visit but had developed clinical and biochemical evidence of hyperthyroidism on the second visit with serum potassium levels of 1.9 mmol/l; and he was eventually diagnosed with TPP. His paralysis resolved with correction of the hypokalemia. It is important to evaluate patients presenting with paralysis comprehensively. Less common differential diagnosis such as TPP may also be considered in such patients to ensure early diag...
Background: Logistic and socioeconomic barriers limit effective blood pressure (BP) control in ma... more Background: Logistic and socioeconomic barriers limit effective blood pressure (BP) control in many parts of Sub-Saharan Africa, including the Republic of Ghana. We tested a novel hypertension management model of care designed for resource-limited settings. Methods and Results: The “Akoma Pa” model was developed using human-centered design methodology involving patients, physicians, and nurses. The model consisted of a mobile tablet, BP machine and a novel software application in a unique platform to allow for longitudinal patient management. Patients were provided with a tailored hypertension management plan based on their enrollment comorbidities and risk factors. A cohort of 150 hypertensive patients (57±8 years; 73% female) accessed regular blood pressure assessments at a local pharmacy and received real-time automated feedback based on their individualized plan. On the mobile application, clinicians were able to view patient data, provide patients with feedback via SMS on their...
Atrial Septal Aneurysm (ASA) can be congenital or acquired, and rarely reported in sub-Saharan Af... more Atrial Septal Aneurysm (ASA) can be congenital or acquired, and rarely reported in sub-Saharan African population. A number of studies have reported an association between ASA and cardiac arrhythmias; few studies have reported on association of ASA and cardiac conduction abnormalities. We report a case of ASA and intermittent atrio-ventricular (AV) block were detected on echocardiography and 24-hour ambulatory electrocardiography in a 65-year-old woman who presented with recurrent palpitations. This case report shows that ASA may not be as rare in sub-Saharan African populations as it is thought. More echocardiographic studies on ASA are needed to understand the prevalence and the impact of ASA in these populations.
Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine, 2020
Background: There is a dearth of publications on the prevalence of venous thromboembolism in Ghan... more Background: There is a dearth of publications on the prevalence of venous thromboembolism in Ghana. Knowledge of the prevalence of venous thromboembolism, which is often undetected clinically, will help save lives as appropriate interventions can be made as well as provide a general clue to clinicians on detecting venous thromboembolism and pulmonary embolism. Methods: The study employs a retrospective design with data extracted from the Autopsy Daybook of the Pathology unit, Komfo Anokye Teaching Hospital, 2009 to 2016. Data on patients’ demographics were retrieved to establish diagnoses and age and gender distribution. Analysis was made of pulmonary embolism and deep vein thrombosis as a cause of death recorded on death certificates using the criteria of the International Classification of Diseases, version 10. Results: A total of 150 cases of deep vein thrombosis and/or pulmonary embolism were available for the study period and the results showed an average age of 45.3 years with...
BackgroundSub-Saharan Africa (SSA) has the highest prevalence of cardiovascular diseases (CVD). N... more BackgroundSub-Saharan Africa (SSA) has the highest prevalence of cardiovascular diseases (CVD). Nevertheless, very few studies have directly examined the development of and risk factors for CVD among Africans.ObjectiveTo examine CVD risk factors and outcomes particularly in the early stage of CVD development among adults in Ghana.MethodsUsing a stratified multistage random sampling method, 1,106 participants were recruited as a nationally representative sample of the general population ≥18 years in Ghana from 2016 to 2017. For each participant, we measured CVD risk factors and preclinical target organ damage (TOD) for CVD development.ResultsThe prevalence of CVD risk factors was 21.1% for obesity, 10.8% for diabetes, 55.4% for hypertension, 37.3% for dyslipidemia, 12.8% for hyperuricemia, and 39.3% for hsCRP>3 mg/L in the recruited population. The prevalence of preclinical TOD was 8.6% for peripheral artery disease (PAD), 14.7% for carotid thickening, 5.9% for left ventricular hy...
Objective: A novel locally appropriate hypertension management model of care was developed and te... more Objective: A novel locally appropriate hypertension management model of care was developed and tested in the Republic of Ghana to address specific socioeconomic and community-related barriers to blood pressure (BP) control. Design and Methods: Patients with a history of hypertension were enrolled and each agreed to visit a participating nearby community pharmacy at least once per week for 6 months for a BP check, symptom review, and medication monitoring. Weekly pharmacy visit data were manually logged into a mobile application by the pharmacy staff. Guideline based logic in the application provided immediate feedback to the patient and transmitted data to the primary physician. Electronic prescriptions, from the primary physician, were accessible to participating pharmacies. Clinic blood pressure from the prior 6 months was also retrieved from patient records. Results: Compliance with weekly BP assessments in the 150 enrolled patients (57± 8 years; 73% Female) was 61% and 2705 tota...
Prevalence of cardiovascular disease in Africa has increased in recent years. Studies suggest tha... more Prevalence of cardiovascular disease in Africa has increased in recent years. Studies suggest that cardiovascular disease will soon be the most important cause of morbidity and mortality in Africa. The objective of this study was to determine the prevalence of cardiovascular risk factors in patients presenting to the cardiac clinic of the Department of Medicine, Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Medical records of 432 patients were selected from the cardiac clinic, using simple random sampling. The demographic characteristics of the patients together with the prevalence of cardiovascular disease risk factors were examined. The patients were aged between 13 - 97 years with the mean age (+/-standard deviation) of 55.35 (+/-19) years. There were more females 229 (53 %) than males 203 (47 %). The main cardiovascular risk factors seen included: hypertension (48.4 %), overweight and obesity (46.3 %), dyslipidaemia (43 %), Electrocardiographic left ventricular hypertrop...
The estimated rate of sudden cardiac death (SCD) in Western countries ranges from 300,000 to 400,... more The estimated rate of sudden cardiac death (SCD) in Western countries ranges from 300,000 to 400,000 annually, which represents 0.36 to 1.28 per 1 000 inhabitants in Europe and the United States. The burden of SCD in Africa is unknown. Our aim is to assess the epidemiology of SCD in Africa. The Pan-Africa SCD study is a prospective, multicentre, community-based registry monitoring all cases of cardiac arrest occurring in victims over 15 years old. We will use the definition of SCD as 'witnessed natural death occurring within one hour of the onset of symptoms' or 'unwitnessed natural death within 24 hours of the onset of symptoms'. After approval from institutional boards, we will record demographic, clinical, electrocardiographic and biological variables of SCD victims (including survivors of cardiac arrest) in several African cities. All deaths occurring in residents of districts of interest will be checked for past medical history, circumstances of death, and autopsy report (if possible). We will also analyse the employment of resuscitation attempts during the time frame of sudden cardiac arrest (SCA) in various patient populations throughout African countries. This study will provide comprehensive, contemporary data on the epidemiology of SCD in Africa and will help in the development of strategies to prevent and manage cardiac arrest in this region of the world.
The surge in prevalence of chronic noncommunicable diseases like hypertension and chronic kidney ... more The surge in prevalence of chronic noncommunicable diseases like hypertension and chronic kidney disease has been linked with modifiable lifestyle practices and increased body fat. This study sought to compare the association between different modifiable lifestyle practices, adiposity indices, renal function parameters, and hypertension as well as the predictive implications for levels of these parameters in target cardiac organ damage among an urban Ghanaian hypertensive population. Using a hospital-based case-control study design, 241 Ghanaian indigenes from the Kumasi metropolis were recruited for this study. The case group was made up of 180 hypertensives and 61 normotensives served as controls. In addition to sociodemographic data, standard haemodynamic, anthropometric, renal function, and cardiac organ damage assessments were done. The prevalence of chronic kidney disease (CKD) ranged from 13.3% to 16.6% depending on the equation used in estimating the glomerular filtration ra...
Background: Cardiovascular disease (CVD) is a major cause of morbidity and hypertension is the si... more Background: Cardiovascular disease (CVD) is a major cause of morbidity and hypertension is the single most important modifiable risk. Assessment of an individual’s “total” predicted risk of developing a CVD event in 5- or 10-years using risk scores has been identified as an accurate measure of CVD risk. Using the latest Framingham risk score we assessed the risk among patients attending two cardiac clinics in Kumasi.Methods: We conducted a hospital-based cross-sectional study among 441 patients attending two cardiac clinics in Kumasi, the Ashanti region of Ghana. Hospital records were reviewed and information on demography, social history and laboratory results for the lipid profile tests were extracted.Results: The prevalence of low, medium and high risk were 41.5%, 28.1% and 30.4% respectively. More men were at high risk compared to females (36.0% vs 23.9%, p=0.003). The risk score showed good discrimination for cardiovascular risk stratification with an overall area under the cur...
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