Mary Mooney1, Gabrielle McKee1, Gerard Fealy2, Frances O' Brien1, Sharon O'Donnell1, Debra Moser3. 1. School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland. 2. School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, Ireland. 3. College of Nursing, University of Kentucky, Lexington, Kentucky.
Abstract
BACKGROUND: The literature suggests that people delay too long prior to attending emergency departments with acute coronary syndrome (ACS) symptoms. This delay is referred to as prehospital delay. Patient decision delay contributes most significantly to prehospital delay. OBJECTIVES: Using a randomized controlled trial, we tested an educational intervention to reduce patient prehospital delay in ACS and promote appropriate responses to symptoms. METHODS:Eligible patients who were admitted across five emergency departments (EDs) in Dublin were recruited to the study (n = 1944; control: 972, intervention: 972). RESULTS:Median baseline prehospital delay times did not differ significantly between the groups at baseline (Mann-Whitney U, p = 0.34) (CONTROL: 4.28 h, 25(th) percentile = 1.71, 75(th) percentile = 17.37; Intervention 3.96 h, 25(th) percentile = 1.53, 75(th) percentile = 18.51). Both groups received usual in-hospital care. In addition, patients randomized to the intervention group received a 40-min individualized education session using motivational techniques. This was reinforced 1 month later by telephone. Of the 1944, 314 (16.2%) were readmitted with ACS symptoms: 177 (18.2%) and 137 (14.1%) of the intervention and control groups, respectively. Prehospital delay times were again measured. Median delay time was significantly lower in the intervention compared to the control group (1.7 h vs. 7.1 h; p ≤ 0.001). Appropriately, those in the intervention group reported their symptoms more promptly to another person (p = 0.01) and fewer consulted a general practitioner (p = 0.02). There was no significant difference in ambulance use (p = 0.51) or nitrate use (p = 0.06) between the groups. CONCLUSION: It is possible to reduce prehospital delay time in ACS, but the need for renewed emphasis on ambulance use is important.
RCT Entities:
BACKGROUND: The literature suggests that people delay too long prior to attending emergency departments with acute coronary syndrome (ACS) symptoms. This delay is referred to as prehospital delay. Patient decision delay contributes most significantly to prehospital delay. OBJECTIVES: Using a randomized controlled trial, we tested an educational intervention to reduce patient prehospital delay in ACS and promote appropriate responses to symptoms. METHODS: Eligible patients who were admitted across five emergency departments (EDs) in Dublin were recruited to the study (n = 1944; control: 972, intervention: 972). RESULTS: Median baseline prehospital delay times did not differ significantly between the groups at baseline (Mann-Whitney U, p = 0.34) (CONTROL: 4.28 h, 25(th) percentile = 1.71, 75(th) percentile = 17.37; Intervention 3.96 h, 25(th) percentile = 1.53, 75(th) percentile = 18.51). Both groups received usual in-hospital care. In addition, patients randomized to the intervention group received a 40-min individualized education session using motivational techniques. This was reinforced 1 month later by telephone. Of the 1944, 314 (16.2%) were readmitted with ACS symptoms: 177 (18.2%) and 137 (14.1%) of the intervention and control groups, respectively. Prehospital delay times were again measured. Median delay time was significantly lower in the intervention compared to the control group (1.7 h vs. 7.1 h; p ≤ 0.001). Appropriately, those in the intervention group reported their symptoms more promptly to another person (p = 0.01) and fewer consulted a general practitioner (p = 0.02). There was no significant difference in ambulance use (p = 0.51) or nitrate use (p = 0.06) between the groups. CONCLUSION: It is possible to reduce prehospital delay time in ACS, but the need for renewed emphasis on ambulance use is important.
Authors: Hee Sook Kim; Kun Sei Lee; Sang Jun Eun; Si Wan Choi; Dae Hyeok Kim; Tae Ho Park; Kyeong Ho Yun; Dong Heon Yang; Seok Jae Hwang; Ki Soo Park; Rock Bum Kim Journal: Yonsei Med J Date: 2017-07 Impact factor: 2.759
Authors: Barbara Farquharson; Purva Abhyankar; Karen Smith; Stephan U Dombrowski; Shaun Treweek; Nadine Dougall; Brian Williams; Marie Johnston Journal: Open Heart Date: 2019-02-27
Authors: Shiwani Mahajan; Javier Valero-Elizondo; Rohan Khera; Nihar R Desai; Ron Blankstein; Michael J Blaha; Salim S Virani; Bita A Kash; William A Zoghbi; Harlan M Krumholz; Khurram Nasir Journal: JAMA Netw Open Date: 2019-12-02