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Acute myocardial infarction under-diagnosis and mortality in a Tanzanian emergency department: A prospective observational study.
Abstract
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.
Type
Journal articleSubject
HumansMyocardial Infarction
Prevalence
Prospective Studies
Adult
Aged
Middle Aged
Emergency Service, Hospital
Tanzania
Female
Male
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https://hdl.handle.net/10161/21625Published Version (Please cite this version)
10.1016/j.ahj.2020.05.017Publication Info
Hertz, Julian T; Sakita, Francis M; Kweka, Godfrey L; Limkakeng, Alexander T; Galson,
Sophie W; Ye, Jinny J; ... Bloomfield, Gerald S (2020). Acute myocardial infarction under-diagnosis and mortality in a Tanzanian emergency
department: A prospective observational study. American heart journal, 226. pp. 214-221. 10.1016/j.ahj.2020.05.017. Retrieved from https://hdl.handle.net/10161/21625.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
John Alexander Bartlett
Professor of Medicine
My clinical investigation is focused on the pathogenesis and treatment of HIV infection
and its complications, especially in resource-limited settings. Key Words: HIV infection,
AIDS, treatment strategies, treatment failure, co-infections, resource-limited settings
Janet Prvu Bettger
Adjunct Associate in the Department of Orthopaedic Surgery
Dr. Bettger’s research is dedicated to establishing real world evidence aimed to improve
health care quality and policies that reduce the burden of disease and disability.
As a health services researcher and implementation scientist, her research extends
from observational studies to randomized and pragmatic trials. She was the Founding
Director of Duke Roybal Center for Translational Research in the Behavioral and Social
Sciences of Aging and the Founding Director of Undergraduate
Gerald Bloomfield
Associate Professor of Medicine
Sophie Wolfe Galson
Assistant Professor of Emergency Medicine
Dr. Galson graduated from Mount Sinai School of Medicine and completed her residency
in Emergency Medicine at the University of Arizona. She has always had a love for
global health and has worked in India, Madagascar and Tanzania during her medical
training. She completed the Global Health Emergency Medicine Fellowship in 2018. Dr.
Galson's research is focused on non-communicable diseases in the emergency department
and linkage to care in Moshi, Tanzania. She
Julian T Hertz
Associate Professor of Emergency Medicine
Julian Hertz, MD, MSc, is an Associate Professor of Emergency Medicine & Global Health.
He graduated summa cum laude from Princeton University and attended medical school
at Duke University, where he received the Dean's Merit Scholarship and the Thomas
Jefferson Award for leadership. He completed his residency training in emergency medicine
at Vanderbilt University Medical Center and his fellowship in Global Health at Duke.Dr.
Hertz's primary interests include globa
Alexander Tan Limkakeng Jr.
Professor of Emergency Medicine
Dr. Alexander T. Limkakeng, Jr., MD, MHSc, FACEP is a Professor of Emergency Medicine,
Vice Chair of Clinical Research, Director of the Acute Care Research Team, and Director
of the Resident Research Fellowship for the Department of Emergency Medicine in the
Duke University School of Medicine in Durham, North Carolina.
Dr. Limkakeng has served as chair of the American College of Emergency Physicians
(ACEP) Research Committee, and been the Course Directo
Blandina Mmbaga
Adjunct Associate Professor of Global Health
Nathan Maclyn Thielman
Professor of Medicine
Broadly, my research focuses on a range of clinical and social issues that affect
persons living with or at risk for HIV infection in resource-poor settings. In Tanzania,
our group is applying novel methods to optimize HIV testing uptake among high-risk
groups. We recently demonstrated that the Discrete Choice Experiment (DCE), a form
of stated preference survey research, is a robust tool for identifying (a) which characteristics
of HIV testing options are most preferred by different populati
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