Julian T Hertz1, Francis M Sakita2, Godfrey L Kweka3, Alexander T Limkakeng4, Sophie W Galson5, Jinny J Ye4, Tumsifu G Tarimo3, Gloria Temu2, Nathan M Thielman6, Janet P Bettger7, John A Bartlett8, Blandina T Mmbaga9, Gerald S Bloomfield10. 1. Division of Emergency Medicine, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC; Duke Global Health Institute, 310 Trent Drive, Durham, NC; Reprint requests: Julian T. Hertz, MD, MScGH, Division of Emergency Medicine, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710.. Electronic address: julian.hertz@duke.edu. 2. Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania; Kilimanjaro Christian Medical University College, PO Box 3010, Moshi, Tanzania. 3. Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania; Kilimanjaro Christian Research Institute, PO Box 2236, Moshi, Tanzania. 4. Division of Emergency Medicine, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC. 5. Division of Emergency Medicine, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC; Duke Global Health Institute, 310 Trent Drive, Durham, NC. 6. Duke Global Health Institute, 310 Trent Drive, Durham, NC; Department of Internal Medicine, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC. 7. Duke Global Health Institute, 310 Trent Drive, Durham, NC; Department of Orthopaedic Surgery, Duke University School of Medicine, 200 Trent Dr, Durham, NC; Duke Clinical Research Institute, 300 W Morgan St, Durham, NC. 8. Duke Global Health Institute, 310 Trent Drive, Durham, NC; Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania; Department of Internal Medicine, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC. 9. Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania; Kilimanjaro Christian Research Institute, PO Box 2236, Moshi, Tanzania; Kilimanjaro Christian Medical University College, PO Box 3010, Moshi, Tanzania. 10. Duke Global Health Institute, 310 Trent Drive, Durham, NC; Division of Cardiology, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC; Duke Clinical Research Institute, 300 W Morgan St, Durham, NC.
Abstract
BACKGROUND: Growing evidence suggests that under-diagnosis of acute myocardial infarction (AMI) may be common in sub-Saharan Africa. Prospective studies of routine AMI screening among patients presenting to emergency departments in sub-Saharan Africa are lacking. Our objective was to determine the prevalence of AMI among patients in a Tanzanian emergency department. METHODS: In a prospective observational study, consecutive adult patients presenting with chest pain or shortness of breath to a referral hospital emergency department in northern Tanzania were enrolled. Electrocardiogram (ECG) and troponin testing were performed for all participants to diagnose AMI types according to the Fourth Universal Definition. All ECGs were interpreted by two independent physician judges. ECGs suggesting ST-elevation myocardial infarction (STEMI) were further reviewed by additional judges. Mortality was assessed 30 days following enrollment. RESULTS: Of 681 enrolled participants, 152 (22.3%) had AMI, including 61 STEMIs and 91 non-STEMIS (NSTEMIs). Of AMI patients, 91 (59.9%) were male, mean (SD) age was 61.2 (18.5) years, and mean (SD) duration of symptoms prior to presentation was 6.6 (12.2) days. In the emergency department, 35 (23.0%) AMI patients received aspirin and none received thrombolytics. Of 150 (98.7%) AMI patients completing 30-day follow-up, 65 (43.3%) had died. CONCLUSIONS: In a northern Tanzanian emergency department, AMI is common, rarely treated with evidence-based therapies, and associated with high mortality. Interventions are needed to improve AMI diagnosis, care, and outcomes.
BACKGROUND: Growing evidence suggests that under-diagnosis of acute myocardial infarction (AMI) may be common in sub-Saharan Africa. Prospective studies of routine AMI screening among patients presenting to emergency departments in sub-Saharan Africa are lacking. Our objective was to determine the prevalence of AMI among patients in a Tanzanian emergency department. METHODS: In a prospective observational study, consecutive adult patients presenting with chest pain or shortness of breath to a referral hospital emergency department in northern Tanzania were enrolled. Electrocardiogram (ECG) and troponin testing were performed for all participants to diagnose AMI types according to the Fourth Universal Definition. All ECGs were interpreted by two independent physician judges. ECGs suggesting ST-elevation myocardial infarction (STEMI) were further reviewed by additional judges. Mortality was assessed 30 days following enrollment. RESULTS: Of 681 enrolled participants, 152 (22.3%) had AMI, including 61 STEMIs and 91 non-STEMIS (NSTEMIs). Of AMI patients, 91 (59.9%) were male, mean (SD) age was 61.2 (18.5) years, and mean (SD) duration of symptoms prior to presentation was 6.6 (12.2) days. In the emergency department, 35 (23.0%) AMI patients received aspirin and none received thrombolytics. Of 150 (98.7%) AMI patients completing 30-day follow-up, 65 (43.3%) had died. CONCLUSIONS: In a northern Tanzanian emergency department, AMI is common, rarely treated with evidence-based therapies, and associated with high mortality. Interventions are needed to improve AMI diagnosis, care, and outcomes.
Authors: Kristian Thygesen; Joseph S Alpert; Allan S Jaffe; Bernard R Chaitman; Jeroen J Bax; David A Morrow; Harvey D White Journal: Glob Heart Date: 2018-08-25
Authors: Sophie W Galson; Catherine A Staton; Francis Karia; Kajiru Kilonzo; Joseph Lunyera; Uptal D Patel; Julian T Hertz; John W Stanifer Journal: BMJ Open Date: 2017-11-09 Impact factor: 2.692
Authors: Julian T Hertz; Deng B Madut; Revogatus A Tesha; Gwamaka William; Ryan A Simmons; Sophie W Galson; Francis M Sakita; Venance P Maro; Gerald S Bloomfield; John A Crump; Matthew P Rubach Journal: PLoS One Date: 2019-02-12 Impact factor: 3.240
Authors: John W Stanifer; Charles R Cleland; Gerald Jamberi Makuka; Joseph R Egger; Venance Maro; Honest Maro; Francis Karia; Uptal D Patel; Matthew J Burton; Heiko Philippin Journal: PLoS One Date: 2016-10-06 Impact factor: 3.240
Authors: Julian T Hertz; Francis M Sakita; Godfrey L Kweka; Tumsifu G Tarimo; Sumana Goli; Sainikitha Prattipati; Janet P Bettger; Nathan M Thielman; Gerald S Bloomfield Journal: Circ Cardiovasc Qual Outcomes Date: 2022-03-18
Authors: Sainikitha Prattipati; Francis M Sakita; Tumsifu G Tarimo; Godfrey L Kweka; Jerome J Mlangi; Amedeus V Maro; Lauren A Coaxum; Sophie W Galson; Alexander T Limkakeng; Anzibert Rugakingira; Sarah J Urasa; Nwora L Okeke; Blandina T Mmbaga; Gerald S Bloomfield; Julian T Hertz Journal: Glob Heart Date: 2022-06-10
Authors: Isaac O Oyediran; Sainikitha Prattipati; Francis M Sakita; Godfrey L Kweka; Tumsifu G Tarimo; Timothy Peterson; Zak Loring; Alexander T Limkakeng; Gerald S Bloomfield; Julian T Hertz Journal: Afr J Emerg Med Date: 2021-10-14