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

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Kweka, Godfrey L

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Bloomfield, Gerald S

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Limkakeng, Alexander T

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Loring, Zak

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Temu, Gloria

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Mmbaga, Blandina T

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Gerardo, Charles J

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Sakita, Francis M

dc.date.accessioned

2020-07-01T16:55:00Z

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2020-07-01T16:55:00Z

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2020-02-06

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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.

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2211-8160

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2211-8179

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https://hdl.handle.net/10161/21132

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eng

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Ubiquity Press, Ltd.

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Global heart

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10.5334/gh.402

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Tanzania

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acute coronary syndrome

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emergency department

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sub-Saharan Africa

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Patterns of Emergency Care for Possible Acute Coronary Syndrome Among Patients with Chest Pain or Shortness of Breath at a Tanzanian Referral Hospital.

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Journal article

duke.contributor.orcid

Hertz, Julian T|0000-0002-7396-4789

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Bloomfield, Gerald S|0000-0002-7176-1611

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Limkakeng, Alexander T|0000-0002-9822-5595

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Loring, Zak|0000-0002-4613-582X

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Mmbaga, Blandina T|0000-0002-5550-1916

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Gerardo, Charles J|0000-0002-8265-1370

pubs.begin-page

9

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1

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School of Medicine

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Duke Clinical Research Institute

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Duke Global Health Institute

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Medicine, Cardiology

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Duke

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Institutes and Centers

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University Institutes and Centers

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Institutes and Provost's Academic Units

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Medicine

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Clinical Science Departments

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Surgery, Emergency Medicine

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Surgery

pubs.publication-status

Published

pubs.volume

15

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