Prognosis of patients with nonspecific electrocardiogram findings in a Tanzanian emergency department.

Background: Nonspecific electrocardiogram (ECG) findings are associated with increased morbidity and mortality in high-income settings. ECGs are increasingly available in emergency departments (EDs) in low- and middle-income countries (LMICs), however the prognostic value of nonspecific ECG findings in resource-limited settings, particularly in sub-Saharan Africa, remains unclear.

Objective: To assess the association between nonspecific ECG findings and 30-day mortality among patients presenting with chest pain and shortness of breath to a Tanzanian ED.

Methods: Patient demographics and initial ECGs were collected from patients presenting with chest pain or shortness of breath to an ED in Moshi, Tanzania from January 2019 through January 2023. Two independent adjudicators interpreted ECGs using standardized criteria. Unadjusted and adjusted (adjusting for age and gender) odds ratios were calculated, and Pearson's chi-squared test was used to assess the association of each ECG finding with 30-day mortality.

Results: Among 1,111 participants, 231 (20.8%) died within 30 days of ED presentation. T-wave inversions (aOR 1.60, 95% CI 1.19-2.15, P = .002), resting tachycardia (aOR 1.57, 95% CI 1.16-2.13, P = .003), non-sinus rhythms (aOR 1.93, 95% CI 1.26-2.96, P = .003), and ST depressions (aOR 1.73, 95% CI 1.17-2.56, P = .006) were significantly associated with increased mortality. There was no significant association between 30-day mortality and left ventricular hypertrophy, bundle branch blocks, or Q waves. Patients with any abnormal ECG finding had higher mortality compared to those with normal ECGs (OR 1.53, 95% CI, 1.08-2.21, P = .019).

Conclusion: Certain nonspecific ECG findings are associated with increased risk of 30-day mortality. Locally tailored risk stratification tools and increased attention to nonspecific ECG changes may enhance ED care in LMICs.