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Hertz JT, Sakita FM, Kweka GL, Tarimo TG, Goli S, Prattipati S, Bettger JP, Thielman NM, Bloomfield GS. One-Year Outcomes and Factors Associated With Mortality Following Acute Myocardial Infarction in Northern Tanzania. Circ Cardiovasc Qual Outcomes 2022; 15:e008528. [PMID: 35300504 PMCID: PMC9018510 DOI: 10.1161/circoutcomes.121.008528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known about long-term outcomes and uptake of secondary preventative therapies following acute myocardial infarction (AMI) in sub-Saharan Africa. METHODS Consecutive patients presenting with AMI (as defined by the Fourth Universal Definition of AMI Criteria) to a northern Tanzanian referral hospital were enrolled in this prospective observational study. Follow-up surveys assessing mortality, medication use, and rehospitalization were administered at 3, 6, 9, and 12 months following initial presentation, by telephone or in person. Multivariate logistic regression was performed to identify baseline clinical and sociodemographic factors associated with one-year mortality. RESULTS Of 152 enrolled patients with AMI, 5 were lost to one-year follow-up (96.7% retention rate). Mortality rates were 34.9% (53 of 152 participants) during the initial hospitalization, 48.7% (73 of 150 patients) at 3 months, 52.7% (78 of 148 patients) at 6 months, 55.4% (82 of 148 patients) at 9 months, and 59.9% (88 of 147 patients) at one year. Of 59 patients surviving to one-year follow-up, 43 (72.9%) reported persistent anginal symptoms, 5 (8.5%) were taking an antiplatelet, 8 (13.6%) were taking an antihypertensive, 30 (50.8%) had been rehospitalized, and 7 (11.9%) had ever undergone cardiac catheterization. On multivariate analysis, one-year mortality was associated with lack of secondary education (odds ratio, 0.26 [95% CI, 0.11-0.58]; P=0.001), lower body mass index (odds ratio, 0.90 [95% CI, 0.82-0.98]; P=0.015), and higher initial troponin (odds ratio, 1.30 [95% CI, 1.05-1.80]; P=0.052). CONCLUSIONS In northern Tanzania, AMI is associated with high all-cause one-year mortality and use of evidence-based secondary preventative therapies among AMI survivors is low. Interventions are needed to improve AMI care and outcomes.
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Affiliation(s)
- Julian T Hertz
- Division of Emergency Medicine (J.T.H.), Duke University School of Medicine, Durham, NC
- Duke Global Health Institute (J.T.H., S.G., S.P., N.M.T., G.S.B.), Duke University, Durham, NC
| | - Francis M Sakita
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania (F.M.S., G.L.K., T.G.T.)
- Kilimanjaro Christian Medical Centre University College, Moshi, Tanzania (F.M.S.)
| | - Godfrey L Kweka
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania (F.M.S., G.L.K., T.G.T.)
| | - Tumsifu G Tarimo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania (F.M.S., G.L.K., T.G.T.)
| | - Sumana Goli
- Duke Global Health Institute (J.T.H., S.G., S.P., N.M.T., G.S.B.), Duke University, Durham, NC
| | - Sainikitha Prattipati
- Duke Global Health Institute (J.T.H., S.G., S.P., N.M.T., G.S.B.), Duke University, Durham, NC
| | - Janet P Bettger
- Department of Orthopaedic Surgery (J.P.B.), Duke University, Durham, NC
- Duke-Margolis Center for Health Policy, Duke University, Washington, District of Colombia (J.P.B.)
| | - Nathan M Thielman
- Department of Internal Medicine (N.M.T.), Duke University School of Medicine, Durham, NC
- Duke Global Health Institute (J.T.H., S.G., S.P., N.M.T., G.S.B.), Duke University, Durham, NC
| | - Gerald S Bloomfield
- Division of Cardiology (G.S.B.), Duke University School of Medicine, Durham, NC
- Duke Global Health Institute (J.T.H., S.G., S.P., N.M.T., G.S.B.), Duke University, Durham, NC
- Duke Clinical Research Institute, Durham, NC (G.S.B.)
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