In response to an NHLBI request for applications, the study seeks to examine outcomes of a one-year community-based, multi-strategy intervention to reduce delay in individuals seeking treatment for acute myocardial infarction (AMI). The major dependent measure is patient delay, defined as the interval between first recognition of symptoms and arrival at hospital (also subdivided into smaller components). In the context of a planned national campaign in this area and as part of an NHLBI cooperative agreement involving other study sites, this study also proposes to examine the feasibility, practicality and processes in applying community-based public health interventions to the problem of reducing patient delay. It is particularly timely given the advances in AMI treatment with early medical care and the recognition that delay times, particularly patient delay, has remained stubbornly. Data for the main outcome measure (delay reduction) will be gathered through a Suspected MI Surveillance Registry, including interviews with suspected AMI patients and abstraction of charts. The study also proposes population cross-section surveys to examine changes in relevant awareness, knowledge, and beliefs about AMI symptoms, appropriate action, and treatment. We propose a randomized design [1] using two pairs of communities (N = 4) of about 100,000 population each for treatment and reference. The intervention will be based on contemporary health education theories. It will be composed of a community organization strategy (formation of a community coalition to give legitimacy to the intervention and to assist in planning and implementation); a mass media campaign; education of high- risk cardiac patients through primary care and hospital clinics; and health professional education. We propose a study period of 48 months including six-months' planning; one-year baseline; one-year intervention; one-year follow-up; and six-months' final analysis.
