Closing gaps in evidence-based care for Acute Myocardial Infarction in northern Tanzania: insights from a prospective study

A prospective study of adults seeking emergency care at Kilimanjaro Christian Medical Centre in northern Tanzania found substantial gaps in the diagnosis and treatment of acute myocardial infarction (AMI). Among 275 participants enrolled between February and September 2023, 41, or 14.9%, met the study’s criteria for AMI. Only 91 participants, 33.1% of the cohort, received both electrocardiography (ECG) and cardiac biomarker testing. Use of evidence-based treatments among participants diagnosed with AMI was lower still: 14, or 34%, received aspirin, 11, or 27%, received clopidogrel, and two, or 5%, received heparin.

Researchers prospectively enrolled adults presenting to the hospital’s emergency department with chest pain or dyspnea and recorded the diagnostic tests and treatments they received. Thirty days after enrollment, investigators conducted telephone follow-up surveys to assess mortality and medication use. Of the 41 participants with AMI, 25, or 61%, were alive at follow-up. Among those survivors, three, or 12%, reported taking dual antiplatelet therapy. The study documented the use and omission of key elements of AMI care in routine emergency-department practice; it did not directly test whether closing those gaps would improve individual outcomes.

The investigators then estimated the potential benefit of addressing the observed care gaps. They annualized the number of participants who had not received each evidence-based therapy and combined those figures with published numbers needed to treat for the relevant interventions. Under this model, closing gaps in the use of aspirin, clopidogrel, heparin and dual antiplatelet therapy at Kilimanjaro Christian Medical Centre could prevent an estimated five deaths and 26 serious cardiovascular events annually. A separate diagnostic estimate suggested that increasing the use of both ECG and cardiac biomarker testing could identify approximately 83 additional AMI cases each year at the hospital. These figures are modeled projections based on observed performance and published treatment-effect estimates, rather than deaths or events directly measured during the prospective follow-up.

An exploratory analysis extended the hospital’s performance metrics using published national incidence data to estimate the potential effects of reducing similar gaps across Tanzania. If performance observed at the study hospital could be applied to the national population, the model projected approximately 56,749 additional AMI cases identified each year, along with 2,768 deaths prevented and 17,967 serious cardiovascular events prevented annually. The national results represent a scale estimate rather than a measured change in Tanzania’s mortality or cardiovascular-event burden. They also depend on transferring treatment-effect estimates from published studies and assuming that care gaps at one hospital are informative about care delivery elsewhere.

Together, the findings show two linked problems in the study setting: many people who entered emergency care did not receive both diagnostic tests needed to identify AMI, and relatively few participants with AMI received several established treatments. The prospective design and collection of test and treatment data provided a locally grounded measure of these gaps, while 30-day follow-up captured short-term survival and medication use among the AMI group. However, the research was conducted in a single emergency department, enrolled a cohort presenting with chest pain or dyspnea, and relied partly on extrapolation for its projected benefits. The results therefore identify a substantial opportunity to expand AMI case detection and improve treatment uptake in northern Tanzania, but they do not demonstrate that a specific intervention at every Tanzanian hospital would produce the estimated national outcomes.

Subject of Research: Prospective assessment of acute myocardial infarction diagnostic and treatment gaps in northern Tanzania

Article Title: Closing gaps in evidence-based care for Acute Myocardial Infarction in northern Tanzania: insights from a prospective study

Article References: Adisa, O., Brown, E. E., Sakita, F. M., Temu, G., Rugakingira, A., Lameck, G., Shayo, F. M., Mmbaga, B. T., Thielman, N. M., Bloomfield, G. S., Bettger, J. P., & Hertz, J. T. (2026). Closing gaps in evidence-based care for Acute Myocardial Infarction in northern Tanzania: insights from a prospective study. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15434-w

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15434-w

Keywords: acute myocardial infarction, Tanzania, emergency department, cardiac biomarkers, electrocardiography, antiplatelet therapy, heparin, aspirin, health services research, cardiovascular outcomes, Closing, gaps