Abstract 1821: A Randomized Controlled Trial to Reduce Prehospital Delay to Treatment in Acute Coronary Syndrome
Background: Delay times from onset of acute coronary syndrome (ACS) symptoms to hospital arrival have remained resistant to change over the past two decades, despite aggressive community education campaigns.
Objectives: We tested a face-to-face education and counseling intervention tailored for patients at high-risk for ACS and delivered on an individual basis. Outcomes were prehospital delay, use of emergency medical services (EMS) and aspirin use.
Methods: Patients (N=3522) with documented coronary heart disease were randomized to one of two groups. Patients in the intervention group (n=1777) received a single education and counseling session from a cardiovascular nurse with one telephone follow-up for purposes of reinforcement. The control group (n=1745) received usual care. Outcomes were measured by medical record review and patient recall. Delay time was log transformed for analyses. Group differences were tested using independent t-tests for continuous data and Chi-square for categorical data.
Results: Patients were 67±11 years old; 67% were male and 45% had history of acute myocardial infarction (AMI). There were no baseline differences between groups on demographic and clinical variables except for gender, with more males in the control group (69.7% vs 66.2%, p=.02). Over the two years of follow-up, 565 (16.0%) patients were admitted to the emergency department with symptoms of ACS. Delay time was available in 490 (86.7%) cases (experimental 89% vs control 84%). There was no significant difference in median delay times between experimental and control (2.12 vs 2.16 hours, p=.584) or in the use of EMS (p=.25). There was a significant difference in the number of patients who took aspirin following the onset of ACS symptoms (experimental 22.8% vs control 11.1%, p=.001).
Conclusion: An intervention tailored for patients at high-risk for AMI and delivered face-to-face did not affect pre-hospital delay time or EMS use. However, the intervention did increase the use of aspirin significantly. The simpler, less threatening aspects of responding appropriately to ACS symptoms are easier to change than the more complex and threatening decision to seek care promptly with the onset of ACS symptoms and use of EMS rather than other modes of transportation.