Ischemic Heart Disease, and primarily Acute Myocardial Infarction (AMI) is the most common cause of death in the United States and in the majority of western industrialized countries (Fraser, 1986, NHLBl 1992). Epidemiologic studies of Coronary Heart Disease have consistently demonstrated that the majority of these deaths occur outside the hospital, are sudden or within one hour of onset of symptoms (Simon ,1972, NHLBl 1992). Yet at least 50% of patients report a delay in seeking medical care of 3-4 hours and one- third of patients may delay longer than 12 hours. (Hackett and Caseem, 1969, Herlitz, 1991). Furthermore, treatment with thrombolytic therapy has now demonstrated evidence for improval in survival rates ranging from 20- 30% when provided early in the course of an evolving MI. However, one- third of patients with acute myocardial infarction have not been eligible for thrombolysis, and 30% of this group were ineligible due to late presentation to the hospital. (Anderson and Willerson, 1993). These early minutes and hours from acute onset of symptoms to receipt of definitive medical care are critical for purposes of 1) preventing or treating fatal arrhythmias (ventricular fibrillation) and 2) for providing the best opportunity for thrombolytic therapy with reperfusion and reduction in myocardial tissue damage. (ACS, AHA Task Force Report, 1990) Large scale efforts to reduce delay in treatment for acute myocardial infarction are now clearly a priority. The objective of this Community Intervention to Reduce Myocardial Infarction Delay is to develop and evaluate the effectiveness of a community-based intervention to reduce delay time for treatment of symptoms and signs of an MI with emphasis on reducing patient decision time to seek care. Six to twelve matched community pairs will be randomized to receive a community-wide intervention over two study years. An on-going hospital record surveillance of rule-out Ml's will be conducted to evaluate the changes in delay time as well as changes in other secondary endpoints (ER visits, EMS use , and out-of -hospital deaths) related to the intervention. The proposed study will provide the opportunity to assess the effects of a multi-factorial intervention to reduce pre-hospital delay with a sufficiently large sample size from geographically representative samples of communities.
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