Patterns of Emergency Care for Possible Acute Coronary Syndrome Among Patients with Chest Pain or Shortness of Breath at a Tanzanian Referral Hospital.
dc.contributor.author | Hertz, Julian T | |
dc.contributor.author | Kweka, Godfrey L | |
dc.contributor.author | Bloomfield, Gerald S | |
dc.contributor.author | Limkakeng, Alexander T | |
dc.contributor.author | Loring, Zak | |
dc.contributor.author | Temu, Gloria | |
dc.contributor.author | Mmbaga, Blandina T | |
dc.contributor.author | Gerardo, Charles J | |
dc.contributor.author | Sakita, Francis M | |
dc.date.accessioned | 2020-07-01T16:55:00Z | |
dc.date.available | 2020-07-01T16:55:00Z | |
dc.date.issued | 2020-02-06 | |
dc.date.updated | 2020-07-01T16:54:58Z | |
dc.description.abstract | Background:Acute coronary syndrome (ACS) is thought to be a rare diagnosis in sub-Saharan Africa, but little is known about diagnostic practices for patients with possible ACS symptoms in the region. Objective:To describe current care practices for patients with ACS symptoms in Tanzania to identify factors that may contribute to ACS under-detection. Methods:Emergency department patients with chest pain or shortness of breath at a Tanzanian referral hospital were prospectively observed. Medical histories were obtained, and diagnostic workups, treatments, and diagnoses were recorded. Five-year risk of cardiovascular events was calculated via the Harvard National Health and Nutrition Examination Survey risk score. Telephone follow-ups were conducted 30 days after enrollment. Results:Of 339 enrolled patients, the median (IQR) age was 60 (46, 72) years, 252 (74.3%) had hypertension, and 222 (65.5%) had >10% five-year risk of cardiovascular event. The median duration of symptoms prior to presentation was 7 days, and 314 (92.6%) reported symptoms worsened by exertion. Of participants, 170 (50.1%) received an electrocardiogram, and 9 (2.7%) underwent cardiac biomarker testing. There was no univariate association between five-year cardiovascular risk and decision to obtain an electrocardiogram (p = 0.595). The most common physician-documented diagnoses were symptomatic hypertension (104 patients, 30.7%) and heart failure (99 patients, 29.2%). Six patients (1.8%) were diagnosed with ACS, and 3 (0.9%) received aspirin. Among 284 (83.8%) patients completing 30-day follow-up, 20 (7.0%) had died. Conclusions:Many patients with ACS risk factors present to the emergency department of a Tanzanian referral hospital with possible ACS symptoms, but marked delays in care-seeking are common. Complete diagnostic workups for ACS are uncommon, ACS is rarely diagnosed or treated with evidence-based therapies, and mortality in patients with these symptoms is high. Physician practices may be contributing to ACS under-detection in Tanzania, and interventions are needed to improve ACS care. | |
dc.identifier.issn | 2211-8160 | |
dc.identifier.issn | 2211-8179 | |
dc.identifier.uri | ||
dc.language | eng | |
dc.publisher | Ubiquity Press, Ltd. | |
dc.relation.ispartof | Global heart | |
dc.relation.isversionof | 10.5334/gh.402 | |
dc.subject | Tanzania | |
dc.subject | acute coronary syndrome | |
dc.subject | emergency department | |
dc.subject | sub-Saharan Africa | |
dc.title | Patterns of Emergency Care for Possible Acute Coronary Syndrome Among Patients with Chest Pain or Shortness of Breath at a Tanzanian Referral Hospital. | |
dc.type | Journal article | |
duke.contributor.orcid | Hertz, Julian T|0000-0002-7396-4789 | |
duke.contributor.orcid | Bloomfield, Gerald S|0000-0002-7176-1611 | |
duke.contributor.orcid | Limkakeng, Alexander T|0000-0002-9822-5595 | |
duke.contributor.orcid | Loring, Zak|0000-0002-4613-582X | |
duke.contributor.orcid | Mmbaga, Blandina T|0000-0002-5550-1916 | |
duke.contributor.orcid | Gerardo, Charles J|0000-0002-8265-1370 | |
pubs.begin-page | 9 | |
pubs.issue | 1 | |
pubs.organisational-group | School of Medicine | |
pubs.organisational-group | Duke Clinical Research Institute | |
pubs.organisational-group | Duke Global Health Institute | |
pubs.organisational-group | Medicine, Cardiology | |
pubs.organisational-group | Duke | |
pubs.organisational-group | Institutes and Centers | |
pubs.organisational-group | University Institutes and Centers | |
pubs.organisational-group | Institutes and Provost's Academic Units | |
pubs.organisational-group | Medicine | |
pubs.organisational-group | Clinical Science Departments | |
pubs.organisational-group | Surgery, Emergency Medicine | |
pubs.organisational-group | Surgery | |
pubs.publication-status | Published | |
pubs.volume | 15 |
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