Implementation Outcomes of an Intervention to Improve Myocardial Infarction Care in Tanzania

Background: Uptake of evidence-based care for acute myocardial infarction (AMI) is limited in Tanzania. To address this, a tailored intervention, the Multicomponent Intervention to Improve Acute Myocardial Infarction Care (MIMIC), was co-designed by an interdisciplinary team. Objectives: To determine implementation outcomes from a pilot trial of the MIMIC intervention in a Tanzanian emergency department (ED). Methods: The MIMIC intervention was implemented by the ED staff for one year. Fidelity, penetration, and costs were observed for each of the intervention components: designated champions to audit care, an online training module for staff, a triage card for nurses to flag patients with AMI symptoms, pocket cards summarizing AMI management for physicians, and an educational pamphlet for patients. Thirty days following enrollment, patient participants were contacted via telephone to inquire whether they had read the pamphlet. Results: Physician champions and nurse champions were actively engaged in the intervention across the twelve-month study period. Fidelity to the pocket card was excellent, with all 22 (100%) physicians observed to have ever brought their pocket cards to work, and penetration across physician-shifts was 96.1% (1835/1910). The training module was started by 20 out of the 22 (91%) physicians and 25 of the 32 (78%) nurses observed. Penetration, measured by module completion, was the same for physicians (20 of 22, 91%) but lower among nurses (21 of 32, 65.6%). Triage cards were used for 453 out of the 577 (78.5%) patients with chest pain or dyspnea. Fidelity to patients with AMI receiving the educational pamphlet was 37.6% (53 of 141). Only 22 of the 39 (56%) surviving AMI patients who received the pamphlet reported reading it, with most of the rest reporting being unaware that they had received it. The total annual cost of the MIMIC intervention was USD 1324.24. Conclusions: There was high variability in fidelity and penetration of the individual intervention components. Future studies should explore reasons for incomplete penetration and analyze cost-effectiveness for scale-up efforts across Tanzania.