Coronary heart disease (CHD) remains the leading mortality cause for all Americans despite rate declines. Treatment innovations, such as thrombolytic therapy, have the potential for decreasing CHD mortality with early treatment after acute myocardial infarction (AMI) onset. Unfortunately, delay in seeking treatment for AMI is unacceptable great, compromising treatment. The overall objective of this proposed four- year, collaborative project is to develop and evaluate a community-based education campaign to reduce delay time from patient recognition and action for symptoms of AMI. We propose three phases: (1) Phase I (Year 01)--for planning during which investigators will meet with NHLBI representatives, other funded centers and consultants to develop the protocol and Manual of Operations (MOO); (2) Phase II (Year 02-03)--for implementing and evaluating the interventions; and (3) Phase II (Year 04)--for data analysis and manuscript preparation. Although we fully anticipate working collaboratively to develop the final protocol, we propose a community-based educational intervention that addresses four, overlapping primary components: a) a tailored and theoretically-based public educational program; b) professional educational programs for emergency department (ED), cardiologists and primary care physicians and nurses, and emergency medical services (EMS) personnel; c) a patient educational program for CHD patients and those at elevated risk; and d) a community organizational component. We propose to conduct the project in four Alabama communities, stratified by demographic characteristics and randomized to intervention and usual care control (we propose 8 intervention and 8 control sites across the Centers). Proposed primary outcomes include change from baseline during two years of follow-up on: a) number of patients contacting EDs and EMS for possible AMI symptoms; b) patient self-reported delay time from symptom onset to initial contact with the health-care system, i.e., decision time; and c) time from initial medical contact to hospital arrival, i.e., medical evaluation/hospital transport time. Proposed secondary outcomes include: a) number of 911 calls for possible AMI symptoms, number of repeat 911 calls, and number of repeat ED visitors with and without definite AMI; b) demographics of ED patients; c) use of thrombolytic therapy and primary; d) number of hospital admissions for chest pain and inpatients with and without AMI, number of patients discharged with a new CHD diagnosis, length of hospital stay for patients with suspected AMI (for confirmed AMI patients and those admitted to rule out AMI both with and without CAD), and number of GXTs, perfusion imaging studies, echoes, and cardiac catheterizations among patients admitted for AMI symptoms; d) mortality in hospital for patients with AMI; and f) patient-reported circumstances surrounding AMI. We also propose process measures to characterize the implementation of the intervention as well as historical and secular trends.
| Osganian, Stavroula K; Zapka, Jane G; Feldman, Henry A et al. (2002) Use of emergency medical services for suspected acute cardiac ischemia among demographic and clinical patient subgroups: the REACT trial. Rapid Early Action for Coronary Treatment. Prehosp Emerg Care 6:175-85 |
| Finnegan Jr, J R; Meischke, H; Zapka, J G et al. (2000) Patient delay in seeking care for heart attack symptoms: findings from focus groups conducted in five U.S. regions. Prev Med 31:205-13 |
