Objectives: The sooner a patient experiencing an acute myocardial infarction (AMI) receives reperfusion therapy the better the outcome. Regrettably, a minority of patients with AMI receive reperfusion therapy, in part due to delays in arriving at the hospital. Lengthy decision making and inappropriate responses to symptoms on the part of the AMI patient are key to prehospital delay intervals. This proposal will test the effectiveness of community-based interventions to decrease prehospital delay intervals among individuals 50 years of age and over who experience symptoms of acute myocardial infarction.
Specific Aims : 1) Evaluate the individual and joint effectiveness of two interventions: (a media-campaign and a community-wide intervention), to decrease prehospital delay intervals for symptoms of AMI. 2) Assess the effectiveness of the interventions in a rural and an urban/suburban community. 3) Determine the impact of the interventions on the use of EMS services and emergency departments, on the use of reperfusion therapy and on AMI mortality. Design and Methods: We propose a randomized controlled intervention trial which targets all individuals at risk of AMI (individuals 50 years of age or over).This study will use two interventions. A media intervention will consist of a public education TV and radio campaign. A community-wide intervention, called the Community Activities Plan, will include both community and interpersonal interventions. A combination of public, patient and health care provider education intervention as well as involvement of community groups that have contact with the target group (such as senior citizen centers, churches, clubs, etc.) will be used. The proposed study identifies four comparable suburban, Pacific Northwest communities (2 in Seattle and 2 in Portland) and two comparable rural communities (l in Seattle, l in Portland). The design will allow us to measure the effects of the separate and combined interventions and compare them to a control community.
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