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Acute myocardial infarction under-diagnosis and mortality in a Tanzanian emergency department: A prospective observational study.

Publication ,  Journal Article
Hertz, JT; Sakita, FM; Kweka, GL; Limkakeng, AT; Galson, SW; Ye, JJ; Tarimo, TG; Temu, G; Thielman, NM; Bettger, JP; Bartlett, JA; Mmbaga, BT ...
Published in: Am Heart J
August 2020

BACKGROUND: Growing evidence suggests that under-diagnosis of acute myocardial infarction (AMI) may be common in sub-Saharan Africa. Prospective studies of routine AMI screening among patients presenting to emergency departments in sub-Saharan Africa are lacking. Our objective was to determine the prevalence of AMI among patients in a Tanzanian emergency department. METHODS: In a prospective observational study, consecutive adult patients presenting with chest pain or shortness of breath to a referral hospital emergency department in northern Tanzania were enrolled. Electrocardiogram (ECG) and troponin testing were performed for all participants to diagnose AMI types according to the Fourth Universal Definition. All ECGs were interpreted by two independent physician judges. ECGs suggesting ST-elevation myocardial infarction (STEMI) were further reviewed by additional judges. Mortality was assessed 30 days following enrollment. RESULTS: Of 681 enrolled participants, 152 (22.3%) had AMI, including 61 STEMIs and 91 non-STEMIS (NSTEMIs). Of AMI patients, 91 (59.9%) were male, mean (SD) age was 61.2 (18.5) years, and mean (SD) duration of symptoms prior to presentation was 6.6 (12.2) days. In the emergency department, 35 (23.0%) AMI patients received aspirin and none received thrombolytics. Of 150 (98.7%) AMI patients completing 30-day follow-up, 65 (43.3%) had died. CONCLUSIONS: In a northern Tanzanian emergency department, AMI is common, rarely treated with evidence-based therapies, and associated with high mortality. Interventions are needed to improve AMI diagnosis, care, and outcomes.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

August 2020

Volume

226

Start / End Page

214 / 221

Location

United States

Related Subject Headings

  • Tanzania
  • Prospective Studies
  • Prevalence
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Female
  • Emergency Service, Hospital
  • Cardiovascular System & Hematology
 

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Hertz, J. T., Sakita, F. M., Kweka, G. L., Limkakeng, A. T., Galson, S. W., Ye, J. J., … Bloomfield, G. S. (2020). Acute myocardial infarction under-diagnosis and mortality in a Tanzanian emergency department: A prospective observational study. Am Heart J, 226, 214–221. https://doi.org/10.1016/j.ahj.2020.05.017
Hertz, Julian T., Francis M. Sakita, Godfrey L. Kweka, Alexander T. Limkakeng, Sophie W. Galson, Jinny J. Ye, Tumsifu G. Tarimo, et al. “Acute myocardial infarction under-diagnosis and mortality in a Tanzanian emergency department: A prospective observational study.Am Heart J 226 (August 2020): 214–21. https://doi.org/10.1016/j.ahj.2020.05.017.
Hertz JT, Sakita FM, Kweka GL, Limkakeng AT, Galson SW, Ye JJ, et al. Acute myocardial infarction under-diagnosis and mortality in a Tanzanian emergency department: A prospective observational study. Am Heart J. 2020 Aug;226:214–21.
Hertz, Julian T., et al. “Acute myocardial infarction under-diagnosis and mortality in a Tanzanian emergency department: A prospective observational study.Am Heart J, vol. 226, Aug. 2020, pp. 214–21. Pubmed, doi:10.1016/j.ahj.2020.05.017.
Hertz JT, Sakita FM, Kweka GL, Limkakeng AT, Galson SW, Ye JJ, Tarimo TG, Temu G, Thielman NM, Bettger JP, Bartlett JA, Mmbaga BT, Bloomfield GS. Acute myocardial infarction under-diagnosis and mortality in a Tanzanian emergency department: A prospective observational study. Am Heart J. 2020 Aug;226:214–221.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

August 2020

Volume

226

Start / End Page

214 / 221

Location

United States

Related Subject Headings

  • Tanzania
  • Prospective Studies
  • Prevalence
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Female
  • Emergency Service, Hospital
  • Cardiovascular System & Hematology