Acute myocardial infarction diagnosis and treatment following implementation of a multicomponent intervention in Tanzania: the MIMIC pilot trial.

BACKGROUND: In Tanzania, acute myocardial infarction (AMI) is underdiagnosed, and uptake of evidence-based care is suboptimal. 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 sequential cohort design trial was conducted in a single northern Tanzanian emergency department (ED). During the preintervention phase (February-August 2023) and the postintervention phase (September 2023-August 2024), adults presenting with chest pain and/or dyspnoea were prospectively enrolled and their ED care was observed. AMI was defined by the Fourth Universal Definition criteria. Telephone follow-ups were conducted to ascertain 30-day mortality. Pearson's χ² was used to compare care before and after MIMIC implementation. RESULTS: A total of 275 participants were enrolled in the preintervention phase and 577 were enrolled in the postintervention phase. Following MIMIC implementation, significant increases were observed in ECG testing (89.4% of postintervention participants vs 55.3% preintervention, OR 6.82, 95% CI 4.79 to 9.79, p<0.001), troponin testing (78.0% of postintervention participants vs 41.4% preintervention, OR 4.99, 95% CI 3.67 to 6.83, p<0.001), and AMI case identification (24.4% of postintervention participants vs 14.9% preintervention, OR 1.84, 95% CI 1.26 to 2.73, p=0.002). Among participants with AMI, significant increases were observed in evidence-based treatment, including aspirin (71.6% among postintervention AMI participants vs 34.4% preintervention, OR 4.80, 95% CI 2.31 to 10.37, p<0.001), clopidogrel (65.2% among postintervention AMI participants vs 26.8% preintervention, OR 5.03, 95% CI 2.37 to 11.39, p<0.001) and heparin (43.2% among postintervention participants vs 4.9% preintervention, OR 13.76, 95% CI 3.99 to 93.79, p<0.001). Thirty-day survival among AMI participants did not change following MIMIC implementation (63.8% among postintervention AMI participants vs 61.0% preintervention, OR 1.31, 95% CI 0.54 to 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 single Tanzanian ED. Multisite studies are needed to evaluate the effect of MIMIC on AMI care in diverse settings across Tanzania. TRIAL REGISTRATION NUMBER: NCT04563546.

Duke Scholars

Author Julian T Hertz Emergency Medicine

Author Gerald Bloomfield Medicine, Cardiology

Author Nathan Maclyn Thielman Medicine, Infectious Diseases