A troubling increase in heart attacks among young people has prompted initiatives to enhance cardiac care capabilities in Nigerian hospitals.
Leading public and private tertiary hospitals are forging unusual partnerships to enable clinical skills transfer and optimal use of technology to tackle the rising prevalence of coronary heart diseases among Nigerians below 50.
With a special focus on developing its capacity in interventional cardiology, the Lagos University Teaching Hospital (LUTH) has signed a memorandum of understanding (MoU) with First Cardiology, Iwosan Lagoon Hospital, Evercare Hospital Lekki and Marcelle Ruth Cancer Centre and Specialist Hospital.
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Ahead of plans to set up a cardiac catheterisation laboratory in 2025, Wasiu Adeyemo, the chief medical director of LUTH said the collaboration will see some doctors and nurses dispatched for training at these private hospitals over the next six months.
Adeyemo said the volume of cases led by non-communicable diseases such as hypertension is evolving into serious public health, requiring expertise in the different specialties of cardiac care.
“Now that we have the expertise in private institutions, LUTH wants to take advantage of collaboration with them to train our people so that when we have the infrastructure in place, we can provide care at an affordable rate to Nigerians,” Adeyemo said, speaking during the hospital’s fourth annual international scientific conference themed: “Interventional Cardiology: Advancing the Frontiers in Cardiovascular Care.”
“They believe that we have some things that they don’t have. We also strongly believe that there are some things that we don’t have. So to collaborate is the way,” Adeyemo said.
Between the ’60s and ’80s, studies show that coronary heart disease, a condition that limits blood flow to the heart’s major blood vessels, was a rarity in Nigeria, about one in 20,000.
But today, experts say it is commonplace for patients to present with risk factors that create the perfect storm for chronic or acute heart conditions.
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Yemi Johnson, an interventional cardiologist and founder of First Cardiology, a specialised cardiac facility in Lagos, said most cases of heart attacks he has seen recently occur among young people in their 50s, 40s, and even 30s.
Although education, enlightenment, and promotion of routine health checks are shifting patterns from late to early presentations, more youths are faced with the risk of heart failure as poor habits dominate people’s lifestyles.
This is driving up demand for procedures like angiography, angioplasty, structural heart interventions, and cardiac biopsies, Johnson said, citing the case of a 57-year-old woman with severe heart failure.
She arrived with fluid buildup in her lungs and an enlarged heart chamber, a condition that is becoming more common.
“For some reason, we are beginning to get heart attacks at a relatively early age, which is not a good sign,” Johnson said.
“It just shows we have developed some of the bad habits of the West, eating fast food, not exercising, not taking our medications for blood pressure and too much fat.
“I’ll classify hypertension as heart disease, and it is a big problem in Africa, and especially in Nigeria,” he added.
Mapping out the historical patterns of coronary artery diseases observed by clinicians over the last seven decades, Akinsanya Olusegun-Joseph, consultant cardiologist at LUTH, cited a study of 8,000 autopsies in the early 60s and 70s.
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The report had only 10 Nigerians associated with heart infarction over 10 years, implying that only one case was recorded among Nigerians in a year. Heart infarction is a tissue death caused by inadequate blood supply to the heart.
But in 2024, Johnson had seen six such patients in less than two weeks.
The researchers including late professor Olufemi Williams had predicted that the severity and prevalence of the disease would not be as low as it was in the 60s if the study had been conducted several years after industrialisation and the standard of living had improved.
“I think it looked beyond, and that is what we are seeing,” Olusegun-Joseph said.
“We have more frequent presentations because there has been improvement in industrialisation and so many things have come into the mix and we need to face it.
“Coronary artery disease is here with us. The presentation is even getting earlier than before. Most times, it’s found in the elderly people, but now we have even younger people,” he added.
He further cited an earlier study of 20 autopsies by Goodale et al, that comprised patients from Uganda, Nigeria, the US, and Kenya, which found that heart infarction was almost non-existent in Africans, whereas in the New York group, it was observed in abundance.
Between 1961 and 1970, a study of heart infarction among 26 patients at the University College Hospital, Ibadan discovered an incidence of one in 20,000.
A similar study at LUTH between 2011 and 2016 found eight cases of heart infarction out of 90, representing 8.9 percent.
The cardiologist said some Nigerians unconsciously cope with the disease until it has advanced into an acute stage, needing emergency intervention.
At this point, blood flow to the heart muscle is restricted, reducing oxygen and nutrient supply, incapacitating the heart from passing out waste products.
Without proper treatment, the patient’s condition can worsen and become fatal.
“There are two possible paths for this patient. In the ideal scenario, we can intervene and modify the risk factors. By doing this, we can potentially halt the progression of the disease and minimise any complications,” Olusegun-Joseph said.
“However, if left untreated, the disease can progress rapidly. This rapid progression can lead to very serious complications in a short amount of time.”
Despite this growing burden, Nigeria does not have enough cardiac catheterisation labs to match the needs of its population.
Oyewole Kushimo, consultant cardiologist at LUTH said the international recommendation is one cath lab for a million people.
But out of about 28 cath labs available in Nigeria, just two are functional in the public state health sector, according to Kushimo.
There are no federal teaching hospitals that have the capacity and the majority of the functional cath labs in Nigeria are private-sector investments, he added.
“This explains why the federal government has taken this as a key priority and you can see most of the labs are in the south of the country,” Kushimo said, noting that it has become imperative for federal health institutions such as LUTH to step in.
As a teaching hospital, LUTH, for instance, has a high patient load that many hospitals do not have, and a functional cath lab would potentially widen access to cardiac care for many Nigerians in Lagos and its environs.
Kusimo also suggested that national health insurance schemes could be developed to provide insurance coverage for those Nigerians who need cardiac care.
“If you have health insurance, increasing access to these procedures would boost volumes and improve training. Higher volumes allow for better training opportunities and lab sustainability. Even with PPPs, patient volume is crucial. In India, their equivalent of NHIS covers these procedures, enabling civil servants to access top teaching or private hospitals through their insurance,” Kusimo said.
