Thirty-Day Outcomes and Predictors of Mortality Following Acute Myocardial Infarction in Northern Tanzania: a Prospective Observational Cohort Study

Abstract

Background: There is a rising burden of myocardial infarction (MI) within sub-Saharan Africa. Prospective studies of detailed MI outcomes in the region are lacking. Methods:Adult patients with confirmed MI from a prospective surveillance study in northern Tanzania were enrolled in a longitudinal cohort study after baseline health history, medication use, barriers to care, and sociodemographics were obtained. Thirty days following hospital presentation, symptom status, rehospitalizations, medication use, and mortality were assessed via telephone or in-person interviews using a standardized follow-up questionnaire. Multivariate logistic regression was performed to identify baseline predictors of thirty-day survival.Results:Thirty-day follow-up was achieved for 150 (98.7%) of 152 enrolled participants. Of these, 85 (56·7%) survived to thirty-day follow-up. Of the surviving participants, 71 (83·5%) reported persistent anginal symptoms, four (4·7%) reported taking aspirin regularly, seven (8·2%) were able to identify MI as the reason for their hospitalization, and 17 (20·0%) had unscheduled rehospitalizations. Baseline predictors of thirty-day survival included self-reported history of diabetes (OR 0·32, 95% CI 0·10-0·89, p = 0·04), self-reported history of hypertension (OR 0·34, 95% CI 0·15-0·74, p = 0·01) and antiplatelet use at initial presentation (OR 0·19, 95% CI 0·04-0·65, p = 0·02).Conclusions:In northern Tanzania, thirty-day outcomes following acute MI are poor, and mortality is associated with comorbidities and medication usage. Further investigation is needed to develop interventions to improve care and outcomes of MI in Tanzania.