{"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":1790400914617,"version":"4.1.0"},"reference-count":31,"publisher":"Ubiquity Press, Ltd.","issue":"1","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["89"],"abstract":"<jats:p>Background: In Tanzania, acute myocardial infarction (AMI) is underdiagnosed, and uptake of evidence\u2011based care remains limited. The Multicomponent Intervention to Improve Myocardial Infarction Care in Tanzania (MIMIC) increased evidence\u2011based AMI care in a pilot trial conducted in a Tanzanian emergency department (ED). Whether MIMIC was sustained as implemented and its gains persisted after the pilot is unknown.\nObjectives: To evaluate the long\u2011term fidelity, penetration, and effectiveness of MIMIC one year after the pilot trial.\nMethods: We conducted a sequential cohort study in a Tanzanian ED, enrolling adults with chest pain or dyspnea during the pilot period (September 2023\u2013August 2024) and post\u2011pilot period (September 2024\u2013August 2025). Pre\u2011intervention data (February\u2013August 2023) served as supplemental baseline. Outcomes included fidelity and penetration of MIMIC components and 11 AMI care metrics. Proportions were compared using Pearson\u2019s \u03c7\u00b2 tests and odds ratios (ORs) with 95% confidence intervals (CIs).\nFindings: Of 260 post\u2011pilot participants, 29 had AMI. Fidelity and penetration of MIMIC components were similar to pilot levels. Electrocardiogram (ECG) uptake remained high (~90% in both periods). Cardiac biomarker testing was lower post\u2011pilot (64.0% [n = 203, excluding stock\u2011out periods] vs 78.0%, OR 0.50, 95% CI 0.35\u20130.72; P &lt; 0.001), coinciding with reagent stock\u2011outs, but exceeding pre\u2011intervention baseline (41.4%). Among AMI participants, treatment with aspirin, clopidogrel, heparin, and statins in the ED was comparable between pilot and post\u2011pilot periods. Compared with the pre\u2011intervention baseline, uptake of diagnostic testing and evidence\u2011based therapies was substantially higher, including a &gt;5\u2011fold increase in 30\u2011day antiplatelet use (10% vs 52%; OR 9.54, 95% CI 2.49\u201346.46; P &lt; 0.001).\nConclusions: One year after implementation, MIMIC demonstrated sustained fidelity, penetration, and clinical effectiveness. AMI care remained substantially improved compared with pre\u2011intervention baseline, suggesting that a pragmatic, workflow\u2011integrated intervention can achieve durable gains in AMI care in a resource\u2011limited ED.<\/jats:p>","DOI":"10.5334\/aogh.5134","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T11:52:41Z","timestamp":1782993161000},"page":"61","source":"Crossref","is-referenced-by-count":1,"title":["Long\u2011Term Implementation and Effectiveness of a Quality Improvement Intervention for Myocardial Infarction in Tanzania"],"prefix":"10.5334","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6543-9768","authenticated-orcid":false,"given":"Claire","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis M","family":"Sakita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarun","family":"Prakash","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Dronzek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thierry","family":"Kabwe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zebadia","family":"Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresia","family":"Joachim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zo\u00eb","family":"Wohlgenant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthi","family":"Vaidyanathan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frida M","family":"Shayo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ally M","family":"Akrabi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria J","family":"Manyangu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan M","family":"Thielman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet P","family":"Bettger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7396-4789","authenticated-orcid":false,"given":"Julian","family":"Hertz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3285","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"issue":"25","key":"key20260702115235_r1","doi-asserted-by":"crossref","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","article-title":"Global burden of cardiovascular diseases and risk factors, 1990\u20132019: Update from the GBD 2019 study","volume":"76","year":"2020","journal-title":"J Am Coll Cardiol"},{"issue":"6","key":"key20260702115235_r2","doi-asserted-by":"crossref","first-page":"102557","DOI":"10.1016\/j.cpcardiol.2024.102557","article-title":"Burden of cardiovascular disease in Sub\u2011Saharan Africa, 1990\u20112019: An analysis of the Global Burden of Disease 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