A Prospective Observational Study of Inpatient Myocardial Infarction Care in Northern Tanzania

Abstract

Background: The uptake of evidence-based secondary preventative therapy among patients with myocardial infarction (MI) patients is low in northern Tanzania, and short-term mortality is high. The aim of this study was to describe current patterns of inpatient and discharge care among hospitalized patients with MI to identify opportunities for improvement.Methods: Adult patients (18 years old) participants with acute MI were consecutively enrolled in the emergency department of a tertiary care hospital in Moshi, Tanzania, from February 2022 through January 2023. A standardized questionnaire collecing demographic and health data was administered to participants at enrollment. During hospitalization, research assistants administered a standardized questionnaire to participants on a daily basis to collect information about symptom progression and counselling received. Information about inpatient testing and treatment were obtained directly from electronic medical records. At time of discharge, a discharge survey was administered to participants to collect information about discharge counseling and post-discharge plans for appointments and medications. Discharge prescriptions were collected directly from the medical record. Thirty days after enrollment, a follow-up survey was administered via telephone to participants to assess symptom status, medication use, and appointment attendance.Results: Of the 73 participants with MI, 21 (29%) died during their initial hospitalization. During the hospital stay: 39 (53%) participants received aspirin, 29 (40%) received clopidogrel, 28 (38%) received dual antiplatelet therapy, 25 (34%) received a beta-blocker, and 36 (49%) received a statin. Fourty-three (59%) participants reported being informed of their diagnosis during their hospitalization, and 21 (29%) reported receiving dietary counselling. Of 9 participants who reported ongoing tobacco use, 2 (22%) reported receiving smoking cessation counseling. Of the 52 participants who survived to hospital discharge, 36 (69%) were given a follow-up appointment, 18 (35%) were prescribed aspirin, 23 (44%) were prescribed clopidogrel, 14 (27%) were prescribed dual antiplatelet therapy, 15 (29%) were prescribed a beta-blocker, and 21 (40%) were prescribed a statin. Four (5%) participants died between discharge and follow-up, resulting in an overall thirty-day mortality rate of 34%. Of the 48 participants surviving to 30 days, 14 (29%) were rehospitalized, 35 (73%) reported ongoing chest pain or dyspnea, 2 (4%) reported taking aspirin, and 4 (8%) reported taking clopidogrel. Conclusions: There are multiple opportunities to improve uptake of evidence-based MI care during the inpatient and discharge phases of care. Further study is needed to address barriers to enhance the quality of MI care and reduce MI-associated mortality.