Acute myocardial infarction diagnosis and treatment following implementation of a multicomponent intervention in Tanzania: the MIMIC pilot trial
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…
How strong is the evidence?
Evidence Hub reads this as a clinical trial, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 275 participants or records.
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