Multicomponent intervention to improve acute myocardial infarction care in Tanzania: Protocol for a pilot implementation trial (Preprint)

BACKGROUND Although the incidence of acute myocardial infarction (AMI) is rising in sub-Saharan Africa, uptake of evidence-based care for the diagnosis and treatment of AMI is limited throughout the region. In Tanzania, studies have revealed common misdiagnosis of AMI, infrequent administration of aspirin, and high short-term mortality rates following AMI. OBJECTIVE This study aims to evaluate the implementation and efficacy outcomes of an intervention, the Multicomponent Intervention to Improve Acute Myocardial Infarction Care (MIMIC), which was developed to improve the delivery of evidence-based AMI care in Tanzania. METHODS This single-arm pilot trial will be conducted in the emergency department (ED) at a referral hospital in northern Tanzania. The MIMIC intervention will be implemented by the ED staff for one year. Approximately 400 adults presenting to the ED with possible AMI symptoms will be enrolled, and research assistants will observe their care. Thirty days later, a follow-up survey will be administered to assess mortality and medication use. The primary outcome will be the acceptability of the MIMIC intervention, which will be measured by the Acceptability of Interventions Measurement (AIM). Acceptability will further be assessed via in-depth interviews with key stakeholders. Secondary implementation outcomes will include feasibility and fidelity. Secondary efficacy outcomes will include: the proportion of participants who receive electrocardiogram and cardiac biomarker testing, the proportion of participants with AMI who receive aspirin, thirty-day mortality among participants with AMI, and the proportion of participants with AMI taking aspirin 30 days following enrollment. RESULTS Implementation of MIMIC began on September 1st, 2023. Enrollment is expected to be completed by September 1st, 2024, and the first results are expected to be published by December 31st, 2024. CONCLUSIONS This study will be the first to evaluate an intervention for improving AMI care in sub-Saharan Africa. If MIMIC is found to be acceptable, the findings from this study will inform a future cluster-randomized trial to assess effectiveness and scalability. CLINICALTRIAL ClinicalTrials.gov NCT04563546; https://clinicaltrials.gov/study/NCT04563546