Acute coronary syndrome prevalence and outcomes in a Tanzanian emergency department: Results from a prospective surveillance study

Background

Preliminary data suggests that the burden of acute coronary syndrome (ACS) is high in Tanzania. After efforts to improve ACS care, we sought to describe ACS diagnosis rates, care processes, and outcomes in a Tanzanian Emergency Department (ED).

Methods

Adults presenting to a northern Tanzanian ED with acute chest pain or shortness of breath were enrolled from November 2020 to January 2023. ACS was defined as per Fourth Universal Definition of Myocardial Infarct criteria. All treatments given in the ED were observed and recorded. Thirty-day follow-up was conducted with all participants via telephone or home visit.

Results

Of 568 participants with chest pain or shortness of breath, 129 (22.7 %) had ACS, including 61 (47 %) with STEMI and 68 (53 %) with non-STEMI. Of participants with ACS, 77 (59.7 %) were male, and the mean (SD) age was 64.5 (16.6) years. The mean duration of symptoms among ACS participants prior to presentation was 2.9 (3.0) days, and 26 (20.2 %) reported no known medical comorbidities. In the ED, 39 (30.2 %) participants with ACS received aspirin and 33 (25.6 %) received clopidogrel. Follow-up was achieved for all 129 ACS participants; 42 (32.6 %) of participants with ACS died within 30 days of presentation. Participants with ACS were significantly more likely to die within 30 days than participants without ACS (32.6 % vs 16.4 %, OR 2.45, 95 % CI: 1.56–3.83, p < 0.001).

Conclusions

ACS is common in a northern Tanzanian ED. Interventions are needed to improve uptake of evidence-based ACS care and reduce ACS-associated mortality.

African relevance

• •
  The study found that 22.7 % of adults presenting with chest pain or shortness of breath in the Tanzanian emergency department (ED) had acute coronary syndrome (ACS). This high prevalence highlights the critical need for enhanced cardiovascular diagnostic and treatment capabilities in Tanzanian and similar African healthcare settings.
• •
  The research reveals significant challenges in managing ACS within resource-constrained settings, where limited access to advanced diagnostic tools like ECGs and cardiac biomarkers contributes to delayed or missed diagnoses, ultimately leading to worse patient outcomes. This situation reflects broader healthcare limitations across sub-Saharan Africa.
• •
  Thirty-day mortality among ACS patients in this study was extremely high (32.6 %), which is substantially higher than ACS mortality rates in high-income countries. These findings underscore the need for urgent interventions to address critical gaps in ACS care in African emergency departments.
• •
  By providing the first prospective data on ACS prevalence and outcomes in a Tanzanian ED, this study fills a critical gap in regional epidemiological knowledge. These insights are essential for informing public health strategies aimed at reducing the burden of cardiovascular diseases in Africa.