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

Hertz, Julian T.; Kweka, Godfrey L.; Bloomfield, Gerald S.; Loring, Zak; Temu, Gloria; Mmbaga, Blandina T.; Gerardo, Charles J.; Sakita, Francis

doi:10.5334/gh.402

Cited by 24 publications

(25 citation statements)

References 27 publications

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“…HF was diagnosed in 26% of patients presenting to the ED with shortness of breath or chest pain, consistent with previous work finding HF to be a leading diagnosis among ED patients with these symptoms in SSA [ 5 , 6 , 28 ]. Importantly, only half the ED patients diagnosed with HF in Tanzania had a known prior diagnosis of HF, whereas the vast majority of HF patients presenting to EDs in high-income settings have a known prior history of HF [ 29 – 31 ].…”

Section: Discussionsupporting

confidence: 86%

“…Moreover, thirty-day outcomes following hospital presentation were poor, with a quarter of HF diagnosis patients dying within 30 days of ED diagnosis and few surviving patients using evidence-based therapies. HF was diagnosed in 26% of patients presenting to the ED with shortness of breath or chest pain, consistent with previous work finding HF to be a leading diagnosis among ED patients with these symptoms in SSA [5,6,28]. Importantly, only half the ED patients diagnosed with HF in Tanzania had a known prior diagnosis of HF, whereas the vast majority of HF patients presenting to EDs in high-income settings have a known prior history of HF [29][30][31].…”

Section: Discussionsupporting

confidence: 84%

“…The burden of cardiovascular disease in sub-Saharan Africa (SSA) has increased as it proceeds through the epidemiological shift from infectious diseases to chronic non-communicable diseases [1]. Heart failure (HF) is a terminal complication of many cardiovascular diseases, and is responsible for a growing number of hospitalizations in SSA [2][3][4][5][6]. With the rapid increase in the prevalence of HF risk factors in SSA, the burden of HF is expected to grow in future years [1,7].…”

Section: Introductionmentioning

confidence: 99%

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Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study

et al. 2021

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Background The burden of heart failure is growing in sub-Saharan Africa, but there is a dearth of data characterizing care and outcomes of heart failure patients in the region, particularly in emergency department settings. Methods In a prospective observational study, adult patients presenting with shortness of breath or chest pain to an emergency department in northern Tanzania were consecutively enrolled. Participants with a physician-documented clinical diagnosis of heart failure were included in the present analysis. Standardized questionnaires regarding medical history and medication use were administered at enrollment, and treatments given in the emergency department were recorded. Thirty days after enrollment, a follow-up questionnaire was administered to assess mortality and medication use. Multivariate logistic regression was performed to identify baseline predictors of thirty-day mortality. Results Of 1020 enrolled participants enrolled from August 2018 through October 2019, 267 patients (26.2%) were diagnosed with heart failure. Of these, 139 (52.1%) reported a prior history of heart failure, 168 (62.9%) had self-reported history of hypertension, and 186 (69.7%) had NYHA Class III or IV heart failure. At baseline, 40 (15.0%) reported taking a diuretic and 67 (25.1%) reported taking any antihypertensive. Thirty days following presentation, 63 (25.4%) participants diagnosed with heart failure had died. Of 185 surviving participants, 16 (8.6%) reported taking a diuretic, 24 (13.0%) reported taking an antihypertensive, and 26 (14.1%) were rehospitalized. Multivariate predictors of thirty-day mortality included self-reported hypertension (OR = 0.42, 95% CI: 0.21–0.86], p = 0.017) and symptomatic leg swelling at presentation (OR = 2.69, 95% CI: 1.35–5.56, p = 0.006). Conclusion In a northern Tanzanian emergency department, heart failure is a common clinical diagnosis, but uptake of evidence-based outpatient therapies is poor and thirty-day mortality is high. Interventions are needed to improve care and outcomes for heart failure patients in the emergency department setting.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

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Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study

et al. 2021

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“…Significant differences in prevalence across studies included reflect disparities in the diagnostic criteria and tools available between SSA countries and the population’s level of knowledge about the symptoms of coronary disease, which can lead to the underdiagnosis of ACS. 41 The limited availability of diagnostic tools (notably troponins) reported in several studies, including those by Kolo et al 33 and Hertz et al in Tanzania, 42 may also explain the low rate of documented MI cases (notably NSTEMI). The widespread use of troponin testing, as in developed countries, allows a greater screening of infarction cases, particularly NSTEMI.…”

Section: Discussionmentioning

confidence: 99%

Acute Coronary Syndromes in Sub‐Saharan Africa: A 10‐Year Systematic Review

Yao

Ekou

Niamkey

et al. 2022

JAHA

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Background Data in the literature on acute coronary syndrome in sub‐Saharan Africa are scarce. Methods and Results We conducted a systematic review of the MEDLINE (PubMed) database of observational studies of acute coronary syndrome in sub‐Saharan Africa from January 1, 2010 to June 30, 2020. Acute coronary syndrome was defined according to current definitions. Abstracts and then the full texts of the selected articles were independently screened by 2 blinded investigators. This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses standards. We identified 784 articles with our research strategy, and 27 were taken into account for the final analysis. Ten studies report a prevalence of acute coronary syndrome among patients admitted for cardiovascular disease ranging from 0.21% to 22.3%. Patients were younger, with a minimum age of 52 years in South Africa and Djibouti. There was a significant male predominance. Hypertension was the main risk factor (50%–55% of cases). Time to admission tended to be long, with the longest times in Tanzania (6.6 days) and Burkina Faso (4.3 days). Very few patients were admitted by medicalized transport, particularly in Côte d'Ivoire (only 34% including 8% by emergency medical service). The clinical presentation is dominated by ST–elevation sudden cardiac arrest. Percutaneous coronary intervention is not widely available but was performed in South Africa, Kenya, Côte d'Ivoire, Sudan, and Mauritania. Fibrinolysis was the most accessible means of revascularization, with streptokinase as the molecule of choice. Hospital mortality was highly variable between 1.2% and 24.5% depending on the study populations and the revascularization procedures performed. Mortality at follow‐up varied from 7.8% to 43.3%. Some studies identified factors predictive of mortality. Conclusions The significant disparities in our results underscore the need for a multicenter registry for acute coronary syndrome in sub‐Saharan Africa in order to develop consensus‐based strategies, propose and evaluate tailored interventions, and identify prognostic factors.

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“…Few published studies have used clustering methodology similar to ours to analyze the evolution of CVRFs. Several studies have analyzed the trajectories of one [ 18 , 19 , 20 , 21 ] or several [ 22 , 23 ] CVRFs using a variety of different methods, and have attempted to identify correlations between their findings and other factors or diseases. One such study [ 19 ] analyzed the evolution of SBP, for which 4 distinct trajectories were identified over time.…”

Section: Discussionmentioning

confidence: 99%