Patterns of Emergency Care for Possible Acute Coronary Syndrome Among Patients with Chest Pain or Shortness of Breath at a Tanzanian Referral Hospital
Key result
Tanzanian emergency departments perform ECGs in only ~50% of patients with possible ACS symptoms.
- n=339
Why the study?
ACS is thought to be rare in sub-Saharan Africa, but diagnostic practices for patients with possible ACS symptoms in the region remain poorly understood.
Population
339 emergency department patients with chest pain or shortness of breath at a Tanzanian referral hospital
Design
Prospective observational study
Follow-up
30 days
Authors
Discussion
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Member takes
Implication
Low diagnostic testing rates for possible ACS in Tanzanian ED patients associate with high mortality; leaves open impact of expanded ECG and biomarker access.
Key Points
- To evaluate emergency department diagnostic practices and management for patients presenting with potential acute coronary syndrome symptoms to identify factors contributing to under-detection.
- Prospective observational study of adult emergency department patients presenting with chest pain or shortness of breath at a referral hospital in Tanzania (N=339).
- Recorded clinical presentations, diagnostic workups, treatments, discharge diagnoses, 5-year cardiovascular risk scores, and 30-day post-enrollment telephone follow-up outcomes.
- Among 339 patients (65.5% with >10% 5-year cardiovascular risk), 50.1% received an electrocardiogram and 2.7% received cardiac biomarker testing, with no significant association between cardiovascular risk and electrocardiogram use (p=0.595).
- Physicians diagnosed acute coronary syndrome in 1.8% of patients (n=6) and prescribed aspirin to 0.9% (n=3), while all-cause mortality reached 7.0% (20/284) at 30-day follow-up.
Study Design
Type
Observational (n=339)
Multicenter
No
Structured PICO
P
Population
339 emergency department patients with chest pain or shortness of breath at a Tanzanian referral hospital, median age 60, 74.3% with hypertension.
O
Outcome
Diagnostic workups, treatments, diagnoses, and 30-day mortality
In a Tanzanian referral hospital, patients presenting with possible ACS symptoms rarely receive complete diagnostic workups or evidence-based therapies, contributing to potential under-detection and high 30-day mortality.
Cite This Study
Hertz et al. (2020) conducted an observational in Possible Acute Coronary Syndrome (n=339). Among emergency department patients with possible ACS symptoms in Tanzania, only 50.1% received an ECG and 2.7% underwent cardiac biomarker testing, with a 30-day mortality of 7.0%.