Physician- and Patient-related Barriers to Diagnosis and Care of Acute Coronary Syndrome in Tanzania

Abstract

Background: Acute coronary syndrome (ACS) is a rare diagnosis in sub-Saharan Africa, but patient and physician-related factors that may contribute to under-diagnosis are poorly understood. Methods: A community survey was performed of adults in northern Tanzania, and respondents were asked to describe symptoms of ACS, personal healthcare-seeking preferences for chest pain, and perceptions of self-risk. A retrospective chart review was conducted at a referral hospital in northern Tanzania to determine rates of various diagnoses among admitted adults over a six-month period. A prospective observational study was conducted in the emergency department, and diagnostic workups, treatments, and diagnoses for adults with chest pain or shortness of breath were recorded. Results: Of 718 survey respondents, 277 (38.6%) stated they would present to a hospital for chest pain and 115 (16.0%) were able to identify a conventional ACS symptom. Retrospectively, ACS accounted for 9 (0.3%) adult admissions, whereas heart failure accounted for 294 (12.2%) admissions. Prospectively, among 339 adults presenting with chest pain or shortness of breath, 170 (50.1%) received an electrocardiogram, 9 (2.7%) underwent cardiac biomarker testing, and 6 (1.8%) were diagnosed with ACS. Conclusions: In northern Tanzania, community awareness of ACS symptoms is low and only a minority of adults would present to a hospital for chest pain. Full diagnostic workups are rare among patients with symptoms of possible ACS, and ACS is a rare diagnosis.