{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T05:35:14Z","timestamp":1790400914624,"version":"4.1.0"},"reference-count":32,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"unspecified","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100016545","name":"Roche Diagnostics","doi-asserted-by":"publisher","award":["SUB-000347"],"award-info":[{"award-number":["SUB-000347"]}],"id":[{"id":"10.13039\/100016545","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart Lung and Blood Institute","doi-asserted-by":"crossref","award":["K23-HL155500"],"award-info":[{"award-number":["K23-HL155500"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,10,21]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In Tanzania, acute myocardial infarction (AMI) is underdiagnosed, and uptake of evidence-based care is suboptimal. 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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This sequential cohort design trial was conducted in a single northern Tanzanian emergency department (ED). During the preintervention phase (February\u2013August 2023) and the postintervention phase (September 2023\u2013August 2024), adults presenting with chest pain and\/or dyspnoea were prospectively enrolled and their ED care was observed. AMI was defined by the Fourth Universal Definition criteria. Telephone follow-ups were conducted to ascertain 30-day mortality. Pearson\u2019s \u03c7\u00b2 was used to compare care before and after MIMIC implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 275 participants were enrolled in the preintervention phase and 577 were enrolled in the postintervention phase. Following MIMIC implementation, significant increases were observed in ECG testing (89.4% of postintervention participants vs 55.3% preintervention, OR 6.82, 95%\u2009CI 4.79 to 9.79, p&lt;0.001), troponin testing (78.0% of postintervention participants vs 41.4% preintervention, OR 4.99, 95%\u2009CI 3.67 to 6.83, p&lt;0.001), and AMI case identification (24.4% of postintervention participants vs 14.9% preintervention, OR 1.84, 95%\u2009CI 1.26 to 2.73, p=0.002). Among participants with AMI, significant increases were observed in evidence-based treatment, including aspirin (71.6% among postintervention AMI participants vs 34.4% preintervention, OR 4.80, 95%\u2009CI 2.31 to 10.37, p&lt;0.001), clopidogrel (65.2% among postintervention AMI participants vs 26.8% preintervention, OR 5.03, 95%\u2009CI 2.37 to 11.39, p&lt;0.001) and heparin (43.2% among postintervention participants vs 4.9% preintervention, OR 13.76, 95%\u2009CI 3.99 to 93.79, p&lt;0.001). Thirty-day survival among AMI participants did not change following MIMIC implementation (63.8% among postintervention AMI participants vs 61.0% preintervention, OR 1.31, 95%\u2009CI 0.54 to 2.31, p=0.739).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The MIMIC intervention was associated with large increases in uptake of AMI testing, case identification and evidence-based treatment in a single Tanzanian ED. Multisite studies are needed to evaluate the effect of MIMIC on AMI care in diverse settings across Tanzania.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04563546\">NCT04563546<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-107857","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T11:46:07Z","timestamp":1762861567000},"page":"e107857","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Acute myocardial infarction diagnosis and treatment following implementation of a multicomponent intervention in Tanzania: the MIMIC pilot trial"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct04563546","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7396-4789","authenticated-orcid":false,"given":"Julian T","family":"Hertz","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA"},{"name":"Duke University Global Health Institute, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua E","family":"Nworie","sequence":"additional","affiliation":[{"name":"Indiana University School of Medicine, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0779-8209","authenticated-orcid":false,"given":"Frida","family":"Shayo","sequence":"additional","affiliation":[{"name":"Department of Emegency Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie Wolfe","family":"Galson","sequence":"additional","affiliation":[{"name":"Surgery, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren A","family":"Coaxum","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ipyana","family":"Daniel","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, St Francis Referral Hospital, Ifakara, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick S","family":"Makambay","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Haydom Lutheran Hospital, Mbulu, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ally M","family":"Akrabi","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Bugando Medical Centre, Mwanza, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria J","family":"Manyangu","sequence":"additional","affiliation":[{"name":"Bugando Medical Centre, Mwanza, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan M","family":"Thielman","sequence":"additional","affiliation":[{"name":"Duke University Global Health Institute, Durham, North Carolina, USA"},{"name":"Department of Medicine, Duke University, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Bloomfield","sequence":"additional","affiliation":[{"name":"Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis M","family":"Sakita","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of"},{"name":"Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,11]]},"reference":[{"key":"2025120413265150000_15.11.e107857.1","doi-asserted-by":"crossref","first-page":"1736","DOI":"10.1016\/S0140-6736(18)32203-7","article-title":"Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980\u20132017: a systematic analysis for the Global Burden of Disease Study 2017","volume":"392","author":"Roth","year":"2018","journal-title":"The Lancet"},{"key":"2025120413265150000_15.11.e107857.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.09.017"},{"key":"2025120413265150000_15.11.e107857.3","first-page":"e82","article-title":"ACC\/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction)","volume":"110","author":"Antman","year":"2004","journal-title":"Circulation"},{"key":"2025120413265150000_15.11.e107857.4","doi-asserted-by":"crossref","unstructured":"Dani SS , Lone AN , Javed Z , et al . Trends in premature mortality from acute myocardial infarction in the United States, 1999 to 2019. J Am Heart Assoc 2022;11. doi:10.1161\/JAHA.121.021682","DOI":"10.1161\/JAHA.121.021682"},{"key":"2025120413265150000_15.11.e107857.5","doi-asserted-by":"crossref","unstructured":"Johansson S , Rosengren A , Young K , et al . Mortality and morbidity trends after the first year in survivors of acute myocardial infarction: a systematic review. BMC Cardiovasc Disord 2017;17. doi:10.1186\/s12872-017-0482-9","DOI":"10.1186\/s12872-017-0482-9"},{"key":"2025120413265150000_15.11.e107857.6","unstructured":"Bloom DE , Chisholm D , Jan\u00e9-Llopis E , et al . From Burden to \u201cBest Buys\u201d: Reducing the Economic Impact of Non-Communicable Diseases. Geneva, Switzerland: World Health Org, 2011."},{"key":"2025120413265150000_15.11.e107857.7","first-page":"64","article-title":"Coronary heart disease in sub-Saharan Africa: still rare, misdiagnosed or underdiagnosed?","volume":"6","author":"Nkoke","year":"2016","journal-title":"Cardiovasc Diagn Ther"},{"key":"2025120413265150000_15.11.e107857.8","doi-asserted-by":"crossref","unstructured":"Hertz JT , Reardon JM , Rodrigues CG , et al . Acute myocardial infarction in sub-Saharan Africa: the need for data. PLoS One 2014;9. doi:10.1371\/journal.pone.0096688","DOI":"10.1371\/journal.pone.0096688"},{"key":"2025120413265150000_15.11.e107857.9","doi-asserted-by":"crossref","unstructured":"Yao H , Ekou A , Niamkey T , et al . Acute coronary syndromes in sub-saharan africa: a 10-year systematic review. J Am Heart Assoc 2022;11. doi:10.1161\/JAHA.120.021107","DOI":"10.1161\/JAHA.120.021107"},{"key":"2025120413265150000_15.11.e107857.10","doi-asserted-by":"crossref","unstructured":"Bahiru E , Agarwal A , Berendsen MA , et al . Hospital-based quality improvement interventions for patients with acute coronary syndrome: a systematic review. Circ Cardiovasc Qual Outcomes 2019;12. doi:10.1161\/CIRCOUTCOMES.118.005513","DOI":"10.1161\/CIRCOUTCOMES.118.005513"},{"key":"2025120413265150000_15.11.e107857.11","doi-asserted-by":"crossref","unstructured":"Allen LN , Pullar J , Wickramasinghe KK , et al . Evaluation of research on interventions aligned to WHO \u201cBest Buys\u201d for NCDs in low-income and lower-middle-income countries: a systematic review from 1990 to 2015. BMJ Glob Health 2018;3. doi:10.1136\/bmjgh-2017-000535","DOI":"10.1136\/bmjgh-2017-000535"},{"key":"2025120413265150000_15.11.e107857.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2020.05.017"},{"key":"2025120413265150000_15.11.e107857.13","doi-asserted-by":"crossref","unstructured":"Hertz JT , Kweka GL , Bloomfield GS , et al . 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;15. doi:10.5334\/gh.402","DOI":"10.5334\/gh.402"},{"key":"2025120413265150000_15.11.e107857.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2021.08.002"},{"key":"2025120413265150000_15.11.e107857.15","doi-asserted-by":"crossref","unstructured":"Hertz JT , Sakita FM , Prattipati S , et al . Improving acute myocardial infarction care in northern Tanzania: barrier identification and implementation strategy mapping. BMC Health Serv Res 2024;24. doi:10.1186\/s12913-024-10831-5","DOI":"10.1186\/s12913-024-10831-5"},{"key":"2025120413265150000_15.11.e107857.16","doi-asserted-by":"crossref","unstructured":"Hertz JT , Stark K , Sakita FM , et al . Adapting an intervention to improve acute myocardial infarction care in Tanzania: co-design of the MIMIC intervention. Ann Glob Health 2024;90. doi:10.5334\/aogh.4361","DOI":"10.5334\/aogh.4361"},{"key":"2025120413265150000_15.11.e107857.17","doi-asserted-by":"crossref","unstructured":"Hertz JT , Sakita FM , Rahim FO , et al . Multicomponent intervention to improve acute myocardial infarction care in Tanzania: protocol for a pilot implementation trial. JMIR Res Protoc 2024;13. doi:10.2196\/59917","DOI":"10.2196\/59917"},{"key":"2025120413265150000_15.11.e107857.18","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/j.gheart.2018.08.004","article-title":"Fourth universal definition of myocardial infarction (2018)","volume":"13","author":"Thygesen","year":"2018","journal-title":"Glob Heart"},{"key":"2025120413265150000_15.11.e107857.19","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2021070988"},{"key":"2025120413265150000_15.11.e107857.20","doi-asserted-by":"publisher","DOI":"10.1093\/inthealth\/ihz061"},{"key":"2025120413265150000_15.11.e107857.21","unstructured":"WHO . From Burden to \u201cBest Buys\u201d: Reducing the Economic Impact of Non-Communicable Diseases in Low and Middle Income Countries. Geneva: Wolrd Health Organization, 2011."},{"key":"2025120413265150000_15.11.e107857.22","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/S0140-6736(88)92833-4","article-title":"Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17 187 cases of suspected acute myocardial infarction: ISIS-2","volume":"332","year":"1988","journal-title":"The Lancet"},{"key":"2025120413265150000_15.11.e107857.23","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.712"},{"key":"2025120413265150000_15.11.e107857.24","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.ahj.2019.01.003","article-title":"Knowledge of myocardial infarction symptoms and perceptions of self-risk in Tanzania","volume":"210","author":"Hertz","year":"2019","journal-title":"Am Heart J"},{"key":"2025120413265150000_15.11.e107857.25","doi-asserted-by":"crossref","unstructured":"Hertz JT , Madut DB , Tesha RA , et al . Perceptions of chest pain and healthcare seeking behavior for chest pain in Northern Tanzania: a community-based survey. PLoS One 2019;14. doi:10.1371\/journal.pone.0212139","DOI":"10.1371\/journal.pone.0212139"},{"key":"2025120413265150000_15.11.e107857.26","doi-asserted-by":"crossref","unstructured":"Hertz JT , Sakita FM , Kweka GL , et al . One-year outcomes and factors associated with mortality following acute myocardial infarction in Northern Tanzania. Circ Cardiovasc Qual Outcomes 2022;15. doi:10.1161\/CIRCOUTCOMES.121.008528","DOI":"10.1161\/CIRCOUTCOMES.121.008528"},{"key":"2025120413265150000_15.11.e107857.27","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.21906"},{"key":"2025120413265150000_15.11.e107857.28","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.413"},{"key":"2025120413265150000_15.11.e107857.29","doi-asserted-by":"crossref","unstructured":"Hertz JT , Sakita FM , Haukila KF , et al . Acceptability and feasibility of a multicomponent intervention to improve acute myocardial infarction care in Northern Tanzania: the MIMIC pilot trial. PLoS One 2025;20. doi:10.1371\/journal.pone.0333271","DOI":"10.1371\/journal.pone.0333271"},{"key":"2025120413265150000_15.11.e107857.30","doi-asserted-by":"crossref","unstructured":"Hertz JT , Sakita FM , Munshi ZR , et al . Implementation outcomes of an intervention to improve myocardial infarction care in Tanzania. Ann Glob Health 2025;91. doi:10.5334\/aogh.4651","DOI":"10.5334\/aogh.4651"},{"key":"2025120413265150000_15.11.e107857.31","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1161\/HYPERTENSIONAHA.114.04394","article-title":"Burden of undiagnosed hypertension in sub-saharan Africa: a systematic review and meta-analysis","volume":"65","author":"Ataklte","year":"2015","journal-title":"Hypertension"},{"key":"2025120413265150000_15.11.e107857.32","doi-asserted-by":"crossref","unstructured":"Stanifer JW , Cleland CR , Makuka GJ , et al . Prevalence, risk factors, and complications of diabetes in the kilimanjaro region: a population-based study from Tanzania. PLoS One 2016;11. doi:10.1371\/journal.pone.0164428","DOI":"10.1371\/journal.pone.0164428"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-107857","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T21:28:34Z","timestamp":1764883714000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-107857"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":32,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,11]]},"published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1136\/bmjopen-2025-107857"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-107857","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11]]}}}