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Patterns of Emergency Care for Possible Acute Coronary Syndrome Among Patients with Chest Pain or Shortness of Breath at a Tanzanian Referral Hospital.

Publication ,  Journal Article
Hertz, JT; Kweka, GL; Bloomfield, GS; Limkakeng, AT; Loring, Z; Temu, G; Mmbaga, BT; Gerardo, CJ; Sakita, FM
Published in: Glob Heart
February 6, 2020

BACKGROUND: Acute coronary syndrome (ACS) is thought to be a rare diagnosis in sub-Saharan Africa, but little is known about diagnostic practices for patients with possible ACS symptoms in the region. OBJECTIVE: To describe current care practices for patients with ACS symptoms in Tanzania to identify factors that may contribute to ACS under-detection. METHODS: Emergency department patients with chest pain or shortness of breath at a Tanzanian referral hospital were prospectively observed. Medical histories were obtained, and diagnostic workups, treatments, and diagnoses were recorded. Five-year risk of cardiovascular events was calculated via the Harvard National Health and Nutrition Examination Survey risk score. Telephone follow-ups were conducted 30 days after enrollment. RESULTS: Of 339 enrolled patients, the median (IQR) age was 60 (46, 72) years, 252 (74.3%) had hypertension, and 222 (65.5%) had >10% five-year risk of cardiovascular event. The median duration of symptoms prior to presentation was 7 days, and 314 (92.6%) reported symptoms worsened by exertion. Of participants, 170 (50.1%) received an electrocardiogram, and 9 (2.7%) underwent cardiac biomarker testing. There was no univariate association between five-year cardiovascular risk and decision to obtain an electrocardiogram (p = 0.595). The most common physician-documented diagnoses were symptomatic hypertension (104 patients, 30.7%) and heart failure (99 patients, 29.2%). Six patients (1.8%) were diagnosed with ACS, and 3 (0.9%) received aspirin. Among 284 (83.8%) patients completing 30-day follow-up, 20 (7.0%) had died. CONCLUSIONS: Many patients with ACS risk factors present to the emergency department of a Tanzanian referral hospital with possible ACS symptoms, but marked delays in care-seeking are common. Complete diagnostic workups for ACS are uncommon, ACS is rarely diagnosed or treated with evidence-based therapies, and mortality in patients with these symptoms is high. Physician practices may be contributing to ACS under-detection in Tanzania, and interventions are needed to improve ACS care.

Duke Scholars

Published In

Glob Heart

DOI

EISSN

2211-8179

Publication Date

February 6, 2020

Volume

15

Issue

1

Start / End Page

9

Location

England

Related Subject Headings

  • Tanzania
  • Risk Factors
  • Risk Assessment
  • Referral and Consultation
  • Prospective Studies
  • Middle Aged
  • Male
  • Incidence
  • Humans
  • Follow-Up Studies
 

Citation

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Hertz, J. T., Kweka, G. L., Bloomfield, G. S., Limkakeng, A. T., Loring, Z., Temu, G., … Sakita, F. M. (2020). Patterns of Emergency Care for Possible Acute Coronary Syndrome Among Patients with Chest Pain or Shortness of Breath at a Tanzanian Referral Hospital. Glob Heart, 15(1), 9. https://doi.org/10.5334/gh.402
Hertz, Julian T., Godfrey L. Kweka, Gerald S. Bloomfield, Alexander T. Limkakeng, Zak Loring, Gloria Temu, Blandina T. Mmbaga, Charles J. Gerardo, and Francis M. Sakita. “Patterns of Emergency Care for Possible Acute Coronary Syndrome Among Patients with Chest Pain or Shortness of Breath at a Tanzanian Referral Hospital.Glob Heart 15, no. 1 (February 6, 2020): 9. https://doi.org/10.5334/gh.402.
Hertz JT, Kweka GL, Bloomfield GS, Limkakeng AT, Loring Z, Temu G, et al. Patterns of Emergency Care for Possible Acute Coronary Syndrome Among Patients with Chest Pain or Shortness of Breath at a Tanzanian Referral Hospital. Glob Heart. 2020 Feb 6;15(1):9.
Hertz, Julian T., et al. “Patterns of Emergency Care for Possible Acute Coronary Syndrome Among Patients with Chest Pain or Shortness of Breath at a Tanzanian Referral Hospital.Glob Heart, vol. 15, no. 1, Feb. 2020, p. 9. Pubmed, doi:10.5334/gh.402.
Hertz JT, Kweka GL, Bloomfield GS, Limkakeng AT, Loring Z, Temu G, Mmbaga BT, Gerardo CJ, Sakita FM. Patterns of Emergency Care for Possible Acute Coronary Syndrome Among Patients with Chest Pain or Shortness of Breath at a Tanzanian Referral Hospital. Glob Heart. 2020 Feb 6;15(1):9.
Journal cover image

Published In

Glob Heart

DOI

EISSN

2211-8179

Publication Date

February 6, 2020

Volume

15

Issue

1

Start / End Page

9

Location

England

Related Subject Headings

  • Tanzania
  • Risk Factors
  • Risk Assessment
  • Referral and Consultation
  • Prospective Studies
  • Middle Aged
  • Male
  • Incidence
  • Humans
  • Follow-Up Studies