Figure 1
Participant flow diagram.
Table 1
Baseline characteristics of adult patients presenting to the KCMC ED with chest pain or shortness of breath in the pilot trial and post‑pilot periods.
| PILOT TRIAL PARTICIPANTS (N = 577) | POST‑PILOT PARTICIPANTS (N = 260) | OR (95% CI) | P | |||
|---|---|---|---|---|---|---|
| CHARACTERISTIC | N | (%) | N | (%) | ||
| Sex | ||||||
| Female | 304 | (52.7) | 147 | (56.5) | 1.17 (0.86–1.59) | 0.330 |
| Male | 273 | (47.3) | 113 | (43.5) | ||
| History of tobacco use | 202 | (35.0) | 78 | (30.0) | 0.80 (0.58–1.09) | 0.178 |
| History of alcohol use | 414 | (71.8) | 178 | (68.5) | 0.85 (0.61–1.19) | 0.367 |
| History of hypertension | 373 | (64.6) | 165 | (62.5) | 0.91 (0.67–1.25) | 0.588 |
| History of diabetes | 158 | (27.4) | 79 | (29.9) | 1.13 (0.81–1.58) | 0.458 |
| History of heart failure | 137 | (23.7) | 79 | (29.9) | 1.37 (0.97–1.92) | 0.062 |
| History of prior MI | 36 | (6.2) | 10 | (3.8) | 0.59 (0.26–1.24) | 0.191 |
| History of stroke | 26 | (4.5) | 7 | (2.7) | 0.58 (0.21–1.39) | 0.252 |
| History of HIV | 19 | (3.3) | 9 | (3.5) | 1.05 (0.41–2.48) | 0.999 |
| PILOT TRIAL PARTICIPANTS (N = 577) | POST‑PILOT PARTICIPANTS (N = 260) | P | ||||
| MEAN | (SD) | MEAN | (SD) | |||
| Age (years) | 62.4 | (17.8) | 62.8 | (17.7) | 0.759 | |
| Symptom duration prior to ED presentation (days) | 4.9 | (11.8) | 6.5 | (10.7) | 0.077 | |
| Systolic BP (mmHg) | 141.8 | (32.6) | 137.4 | (30.9) | 0.062 | |
| Diastolic BP (mmHg) | 82.5 | (20.1) | 78.9 | (17.1) | 0.008* | |
[i] *P < 0.05 using Welch’s t‑test.
Table 2
Fidelity of implementation of the MIMIC intervention in the KCMC ED during the post‑pilot period.
| FIDELITY MEASURE | DENOMINATOR | PILOT TRIAL PARTICIPANTS (N = 577) | POST‑PILOT PARTICIPANTS (N = 260) | OR (95% CI) | P | ||||
|---|---|---|---|---|---|---|---|---|---|
| TOTAL N | OBSERVED N | % | TOTAL N | OBSERVED N | % | ||||
| Proportion of participants with chest pain/dyspnea correctly flagged the “AMI Suspect” triage card | Patient participants with AMI symptoms | 577 | 453 | 78.5% | 260 | 189 | 72.7% | 0.73 (0.51–1.04) | 0.077 |
| Proportion of physicians observed to have ever brought their pocket cards to work | ED physicians | 22 | 22 | 100% | 21 | 21 | 100% | — | — |
| Proportion of ED staff starting the online training module | Total number of ED physicians and nurses | 54 | 45 | 83% | 36 | 31 | 86% | 1.24 (0.33–5.17) | 0.776 |
| Proportion of participants with AMI receiving the educational pamphlet in the ED | Total number of patient participants with confirmed AMI | 141 | 53 | 37.6% | 29 | 12 | 41% | 1.17 (0.47–2.84) | 0.834 |
Table 3
Penetration of implementation of the MIMIC intervention in the KCMC ED during the post‑pilot period.
| PENETRATION MEASURE | DENOMINATOR | PILOT TRIAL PERIOD | POST‑PILOT PERIOD | OR (95% CI) | P | ||||
|---|---|---|---|---|---|---|---|---|---|
| TOTAL N | OBSERVED N | % | TOTAL N | OBSERVED N | % | ||||
| Proportion of nurses working in triage directly observed to use the “AMI Suspect” triage card | Discrete nurse triage‑shift observations | 851 | 572 | 67.2% | 580 | 342 | 60.0% | 0.70 (0.56–0.87) | 0.002* |
| Proportion of physicians directly observed to have their pocket card at work | Discrete physician‑shift observations | 1910 | 1835 | 96.1% | 1539 | 1504 | 97.7% | 1.76 (1.17–2.64) | 0.006* |
| Proportion of ED providers completing the online training module | All ED staff | 54 | 41 | 76% | 36 | 31 | 86% | 1.97 (0.63–6.10) | 0.237 |
| Proportion of surviving participants with AMI who read the educational pamphlet within 30 days | AMI patients who received the educational pamphlet and survived to 30 days | 39 | 22 | 56% | 9 | 6 | 67% | 1.53 (0.28–10.84) | 0.716 |
[i] *P < 0.05.
Table 4
Uptake of diagnostic testing and AMI case detection among adult patients presenting to the KCMC ED with chest pain or shortness of breath.
| PILOT TRIAL PARTICIPANTS (N = 577) | POST‑PILOT PARTICIPANTS (N = 260) | OR (95% CI) | P | |||
|---|---|---|---|---|---|---|
| N | (%) | N | (%) | |||
| ECG obtained | 516 | (89.4) | 232 | (89.2%) | 0.98 (0.60–1.64) | 0.904 |
| Cardiac biomarker obtained | 450 | (78.0) | 130a | (64.0%) | 0.50 (0.35–0.72) | <0.001* |
[i] *P < 0.05.
[ii] aDenominator (N = 203) excludes patients presenting during documented cardiac biomarker assay stock‑outs.
Table 5
Uptake of evidence‑based AMI therapy during and after the MIMIC intervention pilot trial in a Tanzanian ED.
| PILOT TRIAL AMI PARTICIPANTS (N = 141)20 | POST‑PILOT AMI PARTICIPANTS (N = 29) | OR (95% CI) | P* | |||
|---|---|---|---|---|---|---|
| THERAPY | N | (%) | N | (%) | ||
| Aspirin | 101 | (71.6) | 19 | (66) | 0.75 (0.30–1.98) | 0.509 |
| Clopidogrel | 92 | (65.2) | 17 | (59) | 0.76 (0.31–1.89) | 0.532 |
| Heparin | 61 | (43.2) | 9 | (31) | 0.59 (0.22–1.48) | 0.301 |
| Statin | 66 | (46.8) | 17 | (59) | 1.61 (0.67–3.98) | 0.309 |
| Thrombolytic | 14 | (9.9) | 3 | (10) | 1.05 (0.18–4.14) | 0.999 |
| Referral to cardiac center | 19 | (13.5) | 5 | (17) | 1.34 (0.35–4.20) | 0.566 |
[i] *P < 0.05.
Table 6
Thirty‑day outcomes among participants with confirmed AMI.
| THIRTY‑DAY OUTCOME | DENOMINATOR | PILOT TRIAL PARTICIPANTS (N = 141) | POST‑PILOT PARTICIPANTS (N = 29) | OR (95% CI) | P | ||||
|---|---|---|---|---|---|---|---|---|---|
| TOTAL N | OBSERVED N | % | TOTAL N | OBSERVED N | % | ||||
| Proportion of participants with AMI alive at 30 days | Participants with confirmed AMI | 141 | 90 | 63.8% | 29 | 21 | 72% | 1.48 (0.58–4.17) | 0.521 |
| Proportion of participants with AMI taking an antiplatelet at 30 days | Participants with confirmed AMI and 30‑day follow‑up | 141 | 51 | 36.2% | 29 | 15 | 52% | 1.88 (0.78–4.59) | 0.144 |