Background - Individuals who experience the symptoms of acute myocardial infarction (AMI) often delay hours or even days before seeking medical treatment. Median prehospital delay times (i.e., between the onset of cardiac symptoms and arrival at the hospital) have been documented to be 2.0 to 6.0 hours in numerous studies conducted over the past three decades. Such delays result in significant morbidity and mortality. Purpose - We propose a randomized experimental trial to determine whether a one-to-one education and counseling intervention delivered specifically to patients with documented ischemic heart disease will 1) reduce prehospital delay, 2) increase 911 use, and 3) increase aspirin use in those patients who experience AMI symptoms.
Other aims to be tested relate to hypothesized changes in resource utilization; knowledge, attitudes, and beliefs about heart disease and AMI symptoms; and perceived control and anxiety. The effect of various sociodemographic characteristics and means of health care payment on prehospital delay will also be tested. Methods - 5,400 patients with documented ischemic heart disease will be randomized to the experimental intervention or to a care-as-usual control group at six participating sites. The intervention group will receive face-to-face counseling about the symptoms of AMI and the importance of seeking treatment early, as well as 911 and aspirin use. They will also receive telephonic reinforcement of the intervention at one-month follow-up. Data will be collected at baseline, immediately following the intervention, 3, 12, 24 and 36 months. Instruments to be used include the Response Questionnaire (knowledge, attitudes and beliefs), Cardiac Control Index (perceived control), Brief Symptom Inventory Anxiety Subscale, and the Resource Utilization Interview. Prehospital delay, 911 use, aspirin use and resource utilization will be evaluated by means of medical record review and patient interview. It is anticipated that approximately 3% of patients will experience AMI symptoms annually. Analyses. Standard multivariate and repeated measures analysis of variance techniques will be used to test study hypotheses. Significance - All previous interventions have focused on educating e public using mass media, with disappointing results. This study will be the first to test the effectiveness of a one-to-one intervention to reduce prehospital delay. The proposed intervention, if effective, could result in significant improvement in morbidity and mortality of patients with heart disease.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
5R01NR007952-05
Application #
6867400
Study Section
Nursing Research Study Section (NURS)
Program Officer
Huss, Karen
Project Start
2001-06-01
Project End
2007-02-28
Budget Start
2005-03-01
Budget End
2007-02-28
Support Year
5
Fiscal Year
2005
Total Cost
$519,970
Indirect Cost
Name
University of California San Francisco
Department
Other Health Professions
Type
Schools of Nursing
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Moser, Debra K; McKinley, Sharon; Riegel, Barbara et al. (2012) The impact on anxiety and perceived control of a short one-on-one nursing intervention designed to decrease treatment seeking delay in people with coronary heart disease. Eur J Cardiovasc Nurs 11:160-7
Pelter, Michele M; Riegel, Barbara; McKinley, Sharon et al. (2012) Are there symptom differences in patients with coronary artery disease presenting to the ED ultimately diagnosed with or without ACS? Am J Emerg Med 30:1822-8
Riegel, Barbara; Elmi, Angelo; Moser, Debra K et al. (2011) Who listens to our advice? A secondary analysis of data from a clinical trial testing an intervention designed to decrease delay in seeking treatment for acute coronary syndrome. Patient Educ Couns 85:e33-8
Moser, Debra K; McKinley, Sharon; Riegel, Barbara et al. (2011) Relationship of persistent symptoms of anxiety to morbidity and mortality outcomes in patients with coronary heart disease. Psychosom Med 73:803-9
Doering, Lynn V; McKinley, Sharon; Riegel, Barbara et al. (2011) Gender-specific characteristics of individuals with depressive symptoms and coronary heart disease. Heart Lung 40:e4-14
Lee, Christopher S; Moser, Debra K; Lennie, Terry A et al. (2011) Event-free survival in adults with heart failure who engage in self-care management. Heart Lung 40:12-20
Doering, Lynn V; Moser, Debra K; Riegel, Barbara et al. (2010) Persistent comorbid symptoms of depression and anxiety predict mortality in heart disease. Int J Cardiol 145:188-192
Riegel, Barbara; Hanlon, Alexandra L; McKinley, Sharon et al. (2010) Differences in mortality in acute coronary syndrome symptom clusters. Am Heart J 159:392-8
McKinley, Sharon; Dracup, Kathleen; Moser, Debra K et al. (2009) The effect of a short one-on-one nursing intervention on knowledge, attitudes and beliefs related to response to acute coronary syndrome in people with coronary heart disease: a randomized controlled trial. Int J Nurs Stud 46:1037-46
Moser, Debra K; Riegel, Barbara; McKinley, Sharon et al. (2009) The Control Attitudes Scale-Revised: psychometric evaluation in three groups of patients with cardiac illness. Nurs Res 58:42-51

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