The proposed four-year, randomized, controlled, multicenter intervention study is designed to reduce delay time associated with recognition and response to symptoms of acute myocardial infarction (AMI). In this application for a Field Site, we propose to carry out the study in two pairs of cities: 1) Laredo, Texas and Brownsville, Texas; and 2) Tyler, Texas and Lake Charles, Louisiana. Data collection will include 1) telephone surveys of samples of the four cities at baseline and follow-up to assess knowledge, attitudes, and behavioral intentions regarding AMI symptom recognition and response; 2) mid-intervention telephone surveys in the two intervention cities (one from each pair) to assess awareness of the intervention channels and materials and selected attitudes regarding AM symptom recognition and response; 3) in-hospital interviews of patients being evaluated for AMI symptoms regarding symptom onset, recognition, and response; and 4) medical record abstraction for interviewed participants regarding final diagnosis, medical history, hospital course (eg., treatments and complications) and vital status at the time of discharge. The two-year multichannel intervention program will include both """"""""small"""""""" (eg., brochures) and """"""""large"""""""" (eg., television news pieces) media components. Data analysis will include examination of the effect of the intervention on 1) delay time, 2) utilization of emergency medical services and emergency departments, 3) utilization of thrombolytic therapy and immediate angioplasty as therapy for AMI, 4) in-hospital case- fatality, and 5) knowledge, attitudes, and behavioral intentions regarding AMI symptom recognition and response. If successful, this intervention program should serve as a model for dissemination across the U.S. to reduce AMI delay time.
