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

Glob Heart. 2020 Feb 6;15(1):9. doi: 10.5334/gh.402.


Background: Acute coronary syndrome (ACS) is thought to be a rare diagnosis in sub-Saharan Africa, but little is known about diagnostic practices for patients with possible ACS symptoms in the region.

Objective: To describe current care practices for patients with ACS symptoms in Tanzania to identify factors that may contribute to ACS under-detection.

Methods: Emergency department patients with chest pain or shortness of breath at a Tanzanian referral hospital were prospectively observed. Medical histories were obtained, and diagnostic workups, treatments, and diagnoses were recorded. Five-year risk of cardiovascular events was calculated via the Harvard National Health and Nutrition Examination Survey risk score. Telephone follow-ups were conducted 30 days after enrollment.

Results: Of 339 enrolled patients, the median (IQR) age was 60 (46, 72) years, 252 (74.3%) had hypertension, and 222 (65.5%) had >10% five-year risk of cardiovascular event. The median duration of symptoms prior to presentation was 7 days, and 314 (92.6%) reported symptoms worsened by exertion. Of participants, 170 (50.1%) received an electrocardiogram, and 9 (2.7%) underwent cardiac biomarker testing. There was no univariate association between five-year cardiovascular risk and decision to obtain an electrocardiogram (p = 0.595). The most common physician-documented diagnoses were symptomatic hypertension (104 patients, 30.7%) and heart failure (99 patients, 29.2%). Six patients (1.8%) were diagnosed with ACS, and 3 (0.9%) received aspirin. Among 284 (83.8%) patients completing 30-day follow-up, 20 (7.0%) had died.

Conclusions: Many patients with ACS risk factors present to the emergency department of a Tanzanian referral hospital with possible ACS symptoms, but marked delays in care-seeking are common. Complete diagnostic workups for ACS are uncommon, ACS is rarely diagnosed or treated with evidence-based therapies, and mortality in patients with these symptoms is high. Physician practices may be contributing to ACS under-detection in Tanzania, and interventions are needed to improve ACS care.

Keywords: Tanzania; acute coronary syndrome; emergency department; sub-Saharan Africa.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Acute Coronary Syndrome / complications
  • Acute Coronary Syndrome / epidemiology
  • Acute Coronary Syndrome / therapy*
  • Aged
  • Chest Pain / diagnosis*
  • Chest Pain / etiology
  • Chest Pain / therapy
  • Disease Management*
  • Dyspnea / diagnosis
  • Dyspnea / etiology
  • Dyspnea / therapy*
  • Electrocardiography
  • Emergency Medical Services / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Prospective Studies
  • Referral and Consultation / statistics & numerical data*
  • Risk Assessment*
  • Risk Factors
  • Tanzania / epidemiology