Effect of a Multicomponent Intervention on Acute Myocardial Infarction Diagnosis and Treatment in Tanzania: The MIMIC Implementation Trial.

Background: In Tanzania, acute myocardial infarction (AMI) is under-diagnosed, and uptake of evidence-based care is sub-optimal. Using an implementation science approach, an intervention was developed to address local barriers to care: the Multicomponent Intervention for Improving Myocardial Infarction Care in Tanzania (MIMIC). Methods: This single-arm pre-post trial was conducted in a northern Tanzanian emergency department (ED). During the pre-intervention phase (February-August 2023) and the post-intervention phase (September 2023-August 2024), adults presenting with chest pain and/or dyspnea were prospectively enrolled and their ED care was observed. AMI was defined by Fourth Universal Definition criteria. Telephone follow-ups were conducted to ascertain 30-day mortality. Pearson's chi-squared was used to compare care before and after MIMIC implementation. Results: A total of 275 participants were enrolled in the pre-intervention phase and 577 were enrolled in the post-intervention phase. Following MIMIC implementation, significant increases were observed in ECG testing (89.4% of post-intervention participants vs 55.3% pre-intervention, OR 6.82, 95% CI: 4.79-9.79, Conclusions: The MIMIC intervention was associated with large increases in uptake of AMI testing, case identification, and evidence-based treatment in a Tanzanian ED.