Management of cardiovascular diseases in kabul NATO role 3 hospital: A 15-week-long experience

Abstract

Introduction. Between 2009 and 2014, Kabul NATO role 3 hospital provided comprehensive medical services to NATO troops engaged in Afghanistan as well as care for Afghan national security forces and for Afghan and non-Afghan civilians. This study aims at describing the occurrence and the management of cardiovascular diseases in patients presenting to the emergency room or the outpatient clinic or hospitalized for a noncardiovascular reason over a 15-week-long period. Materials and Methods. The patients for whom cardiologic advice was sought between June 16th and October 1st, 2012, were prospectively included. Demographic and medical data were recorded for each patient. Statistical analysis was performed with Epi Info 3.5.1 software. For continuous variables, data are expressed as mean ± SD. Qualitative variables are expressed as percentages. Results. Cardiologic advice was sought for 52 patients. The patients initially presenting for a cardiovascular reason were mainly non-Afghans; 34.2% of them were experiencing acute coronary syndromes, among whom 76.9% were civilians, working in Afghanistan for non-Afghan companies, and 30.8% had known cardiomyopathies or unexplored symptoms before leaving for Afghanistan. Most of them accumulated cardiovascular risk factors. Three patients among the four presenting with ST-segment elevation acute coronary syndromes presented serious complications (respectively, death, acute heart failure, and failed thrombolysis with no possibility to perform rescue percutaneous coronary intervention). Acute heart failure, acute pulmonary embolism and acute coronary syndrome were the most common reasons for seeking cardiologic advice about patients hospitalized for noncardiovascular diseases. Conclusion. Reasons for seeking cardiologic advice were diverse but acute coronary syndromes in frequently high-risk non-Afghan patients were the most frequent and serious ones. The lack of appropriate diagnostic and therapeutic means available within reasonable time resulted in serious complications for most patients presenting with ST-segment elevation myocardial infarction. Consequently a medical selection seems necessary for civilians sent to work in such conditions, as performed for military personnel. The management of Afghan patients was mainly limited by the lack of local medical infrastructure.