Thrombolysis as Part of Acute ST-Segment Elevation Myocardial Infarction (STEMI) Care: Experience From the STEMI...

Background and objective The burden of ischaemic heart disease (IHD) in low- and middle-income countries (LMIC) is increasing worldwide. A significant proportion of hospitalizations and deaths have been attributed to this condition. Promoting good clinical outcomes in patients with IHD requires timely diagnosis and management using percutaneous coronary intervention (PCI) and recommended pharmacotherapy. Fibrinolytics, combined with antiplatelet and anticoagulant agents, are recommended as initial therapy in resource-limited settings. The regional systems, which aim to provide access to timely percutaneous intervention for patients with ST-elevation myocardial infarction (STEMI), are still in their infancy stages in Tanzania. However, these systems have shown promising results in coordinated patient management. This survey was conducted through a network to gain an understanding of the general context of IHD management. This study aimed to assess the current service availability, infrastructure in place, and the duration of time taken between various referral centers in different zones. Methodology An online cross-sectional survey was conducted between May and June 2023, involving medical practitioners from facilities in mainland Tanzania and Zanzibar. Physicians from various regional centers were invited to complete an anonymous online survey about the available STEMI services and their familiarity with the pathway. Information on geography, available expertise, equipment, and medicines at these facilities was collected and analyzed using R software, version 4.3.1. Proportion and frequencies were the primary measures for assessing the capacity and distribution of these facilities. A chi-square test was used to compare these parameters between public and private facilities, with the significance level set at p<0.05. All ethical standards were adhered to, and approval was obtained from the ethics committee. Results Among the 66 clinicians from mainland Tanzania and Zanzibar, 36 (54.5%) worked in public facilities, while 30 (45.5%) worked in private facilities. Clinician responses from the coastal regions were obtained from 18 (50%) public facilities and 10 (33%) private facilities, indicating an uneven distribution of thrombolysis and primary angioplasty services in this region. Only a quarter (n=9, 25%) of clinicians from the public and less than half (n=14, 47%) of the clinicians from private facilities reported the availability of thrombolytic medications in their facilities. Moreover, 11 (31%) and seven (23%) clinicians from private and public facilities, respectively, could refer patients for advanced care within the recommended 90 minutes after initial medical contact. Primary angioplasty services were concentrated in the coastal and central regions of the country, with four catheterization laboratories in the Dar es Salaam region (coastal) and one in the Dodoma Region (central).  Conclusions Facilities offering medical services to patients with myocardial infarction (MI) are unevenly distributed in Tanzania, with a concentration mainly in the coastal region. These facilities have established protocols to care for patients with STEMI. The capacity of facilities is generally low and varies between public and private facilities. Further research is necessary to inform policies, and deliberate strategies and efforts are required to address the prevailing situation.