# Developing an intervention to improve quality of myocardial infarction care in northern Tanzania

> **NIH NIH K23** · DUKE UNIVERSITY · 2021 · $168,628

## Abstract

PROJECT SUMMARY
Myocardial infarction (MI) is a leading cause of death worldwide. There is a critical need to improve uptake of
evidence-based care for MI in resource-limited settings. This proposal presents a research career development
program to 1) identify barriers to evidence-based MI care in Tanzania, 2) develop a multicomponent intervention
to improve care by adapting proven strategies from other settings, and 3) assess the feasibility, acceptability,
and potential effectiveness of the intervention. The candidate, an Assistant Professor of Surgery at Duke
University and emergency medicine physician, has experience conducting research regarding MI in Tanzania.
The high MI-associated mortality he identified as an NIH Fogarty Global Health Fellow led him to seek additional
training in implementation science, intervention development, and clinical trial design. Working with a diverse
mentoring committee of experts in implementation research, clinical trials, and global cardiovascular disease, as
well as Tanzanian colleagues with whom he has collaborated for the past ten years, he will build upon his prior
study of MI in northern Tanzania. The proposed activities will equip the candidate with a combination of skills in
global emergency implementation research and position him to become a successful independent investigator
operating at the intersection of global health, emergency medicine, and implementation science.
Growing evidence suggests that in sub-Saharan Africa (SSA), MI is common, frequently misdiagnosed, rarely
treated with evidence-based therapies, and associated with high mortality. Preliminary research conducted by
the candidate in Tanzania found that 22% of patients presenting to the emergency department (ED) with typical
symptoms have an acute MI, but 90% of acute MI cases are missed by ED physicians. The candidate’s research
found a 30-day mortality rate following acute MI of 43%--more than sixfold higher than the mortality rate in the
United States. Such poor MI outcomes are likely related to low uptake of evidence-based MI care; for example,
the candidate’s preliminary data found that only 23% of patients with acute MI were treated with aspirin—a WHO
“best buy” for reducing noncommunicable disease mortality. Despite these alarming data, the barriers to
evidence-based MI care in SSA remain largely unexplored and locally-tailored interventions to improve MI care
in resource limited settings are sorely lacking. There is an urgent need to identify barriers to MI care and to
develop locally-appropriate interventions that will improve MI outcomes in low-income settings like Tanzania.
This proposal will bridge this knowledge gap by using an approach rooted in implementation science.
Specifically, this study will 1) identify barriers to evidence-based diagnosis and treatment of MI in northern
Tanzania, 2) develop a multicomponent tailored intervention to improve MI care, and 3) determine feasibility,
acceptability, and potential effec...

## Key facts

- **NIH application ID:** 10104103
- **Project number:** 1K23HL155500-01
- **Recipient organization:** DUKE UNIVERSITY
- **Principal Investigator:** Julian T Hertz
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $168,628
- **Award type:** 1
- **Project period:** 2021-02-01 → 2026-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10104103

## Citation

> US National Institutes of Health, RePORTER application 10104103, Developing an intervention to improve quality of myocardial infarction care in northern Tanzania (1K23HL155500-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10104103. Licensed CC0.

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