Effect of a Multicomponent Intervention on Acute Myocardial Infarction Diagnosis and Treatment in Tanzania: The MIMIC Implementation Trial.
BACKGROUND: In Tanzania, acute myocardial infarction (AMI) is under-diagnosed, and uptake of evidence-based care is sub-optimal. Using an implementation science approach, an intervention was developed to address local barriers to care: the Multicomponent Intervention for Improving Myocardial Infarction Care in Tanzania (MIMIC). METHODS: This single-arm pre-post trial was conducted in a northern Tanzanian emergency department (ED). During the pre-intervention phase (February-August 2023) and the post-intervention phase (September 2023-August 2024), adults presenting with chest pain and/or dyspnea were prospectively enrolled and their ED care was observed. AMI was defined by Fourth Universal Definition criteria. Telephone follow-ups were conducted to ascertain 30-day mortality. Pearson's chi-squared was used to compare care before and after MIMIC implementation. RESULTS: A total of 275 participants were enrolled in the pre-intervention phase and 577 were enrolled in the post-intervention phase. Following MIMIC implementation, significant increases were observed in ECG testing (89.4% of post-intervention participants vs 55.3% pre-intervention, OR 6.82, 95% CI: 4.79-9.79, p<0.001), troponin testing (78.0% of post-intervention participants vs 41.4% pre-intervention, OR 4.99, 95% CI: 3.67-6.83, p<0.001), and AMI case identification (24.4% of post-intervention participants vs 14.9% pre-intervention, OR 1.84, 95% CI: 1.26-2.73, p=0.002). Among participants with AMI, significant increases were observed in evidence-based treatment, including aspirin (71.6% among post-intervention AMI participants vs 34.4% pre-intervention, OR 4.80, 95% CI: 2.31-10.37, p<0.001), clopidogrel (65.2% among post-intervention AMI participants vs 26.8% pre-intervention, OR 5.03, 95% CI: 2.37-11.39, p<0.001), and heparin (43.2% among post-intervention participants vs 4.9% pre-intervention, OR 13.76, 95% CI: 3.99-93.79, p<0.001). Thirty-day survival among AMI participants did not change following MIMIC implementation (63.8% among post-intervention AMI participants vs 61.0% pre-intervention, OR 1.31, 95% CI: 0.54-2.31, p=0.739). CONCLUSIONS: The MIMIC intervention was associated with large increases in uptake of AMI testing, case identification, and evidence-based treatment in a Tanzanian ED.
