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

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Date
2020-08
Authors
Hertz, Julian T
Sakita, Francis M
Kweka, Godfrey L
Limkakeng, Alexander T
Galson, Sophie W
Ye, Jinny J
Tarimo, Tumsifu G
Temu, Gloria
Thielman, Nathan M
Bettger, Janet P
Bartlett, John A
Mmbaga, Blandina T
Bloomfield, Gerald S
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(13 total)
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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 article
Subject
Humans
Myocardial Infarction
Prevalence
Prospective Studies
Adult
Aged
Middle Aged
Emergency Service, Hospital
Tanzania
Female
Male
Permalink
https://hdl.handle.net/10161/21625
Published Version (Please cite this version)
10.1016/j.ahj.2020.05.017
Publication 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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Scholars@Duke

Bartlett

John Alexander Bartlett

Professor of Medicine
My clinical investigation is focused on the pathogenesis and treatment of HIV infection and its complicastions, especially in resource-limited settings. Key Words: HIV infection, AIDS, treatment strategies, treatment failure, co-infections, resource-limited settings
Bettger

Janet Prvu Bettger

Associate Professor in 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 is currently the Director of Duke Roybal Center for Translational Research in the Behavioral and Social Sciences of Aging and Director of Undergraduate Initiatives
Bloomfield

Gerald Bloomfield

Associate Professor of Medicine
Galson

Sophie Wolfe Galson

Assistant Professor of Surgery
Hertz

Julian T Hertz

Assistant Professor of Surgery
Limkakeng

Alexander Tan Limkakeng Jr.

Professor of Surgery
My personal research interest is finding new ways to diagnose acute coronary syndrome. In particular, I am interested in novel biomarkers and precision medicine approaches to this problem. I also have an interest in sepsis and empirical bioethics. As Vice Chief of Research for the Duke Division of Emergency Medicine, I also work with researchers from many fields spanning global health, innovation, clinical trials, basic discovery, and translational research. The
Thielman

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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