{
  "abstract": "Background In Tanzania, acute myocardial infarction (AMI) is underdiagnosed, and uptake of evidence-based care is suboptimal. Using an implementation science approach, an intervention was developed to address local barriers to care: the Multicomponent Intervention for Improving Myocardial Infarction Care in Tanzania (MIMIC).Methods This sequential cohort design trial was conducted in a single northern Tanzanian emergency department (ED). During the preintervention phase (February–August 2023) and the postintervention phase (September 2023–August 2024), adults presenting with chest pain and/or dyspnoea were prospectively enrolled and their ED care was observed. AMI was defined by the Fourth Universal Definition criteria. Telephone follow-ups were conducted to ascertain 30-day mortality. Pearson’s χ² was used to compare care before and after MIMIC implementation.Results A total of 275 participants were enrolled in the preintervention phase and 577 were enrolled in the postintervention phase. Following MIMIC implementation, significant increases were observed in ECG testing (89.4% of postintervention participants vs 55.3% preintervention, OR 6.82, 95% CI 4.79 to 9.79, p<0.001), troponin testing (78.0% of postintervention participants vs 41.4% preintervention, OR 4.99, 95% CI 3.67 to 6.83, p<0.001), and AMI case identification (24.4% of postintervention participants vs 14.9% preintervention, OR 1.84, 95% CI 1.26 to 2.73, p=0.002). Among participants with AMI, significant increases were observed in evidence-based treatment, including aspirin (71.6% among postintervention AMI participants vs 34.4% preintervention, OR 4.80, 95% CI 2.31 to 10.37, p<0.001), clopidogrel (65.2% among postintervention AMI participants vs 26.8% preintervention, OR 5.03, 95% CI 2.37 to 11.39, p<0.001) and heparin (43.2% among postintervention participants vs 4.9% preintervention, OR 13.76, 95% CI 3.99 to 93.79, p<0.001). Thirty-day survival among AMI participants did not change following MIMIC implementation (63.8% among postintervention AMI participants vs 61.0% preintervention, OR 1.31, 95% CI 0.54 to 2.31, p=0.739).Conclusions The MIMIC intervention was associated with large increases in uptake of AMI testing, case identification and evidence-based treatment in a single Tanzanian ED. Multisite studies are needed to evaluate the effect of MIMIC on AMI care in diverse settings across Tanzania.Trial registration number NCT04563546.",
  "authors": [
    {
      "affiliations": [
        "Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA",
        "Duke University Global Health Institute, Durham, North Carolina, USA"
      ],
      "name": "Julian T Hertz"
    },
    {
      "affiliations": [
        "Indiana University School of Medicine, Indianapolis, Indiana, USA"
      ],
      "name": "Joshua E Nworie"
    },
    {
      "affiliations": [
        "Department of Emegency Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of"
      ],
      "name": "Frida Shayo"
    },
    {
      "affiliations": [
        "Surgery, Duke University School of Medicine, Durham, North Carolina, USA"
      ],
      "name": "Sophie Wolfe Galson"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA"
      ],
      "name": "Lauren A Coaxum"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, St Francis Referral Hospital, Ifakara, Tanzania, United Republic of"
      ],
      "name": "Ipyana Daniel"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Haydom Lutheran Hospital, Mbulu, Tanzania, United Republic of"
      ],
      "name": "Patrick S Makambay"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Bugando Medical Centre, Mwanza, Tanzania, United Republic of"
      ],
      "name": "Ally M Akrabi"
    },
    {
      "affiliations": [
        "Bugando Medical Centre, Mwanza, Tanzania, United Republic of"
      ],
      "name": "Gloria J Manyangu"
    },
    {
      "affiliations": [
        "Duke University Global Health Institute, Durham, North Carolina, USA",
        "Department of Medicine, Duke University, Durham, North Carolina, USA"
      ],
      "name": "Nathan M Thielman"
    },
    {
      "affiliations": [
        "Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA"
      ],
      "name": "Gerald Bloomfield"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of",
        "Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania, United Republic of"
      ],
      "name": "Francis M Sakita"
    }
  ],
  "title": "Acute myocardial infarction diagnosis and treatment following implementation of a multicomponent intervention in Tanzania: the MIMIC pilot trial",
  "uid": "c1912bb6-d019-59f3-bc73-c43c12562995"
}