• A Randomized Controlled Trial to Reduce Prehospital Delay Time in Patients With Acute Coronary Syndrome (ACS)

    by Alan Batt. Last modified: 10/02/14

    acs

    Summary

    • Randomised, controlled, parallel-group multi-centre trial
    • 2041 patients enrolled; 1944 had definitive diagnosis of ACS & documented prehospital delay in seeking help
      • Intervention group (n=972) received standard care plus 40-min individualized education session using motivational techniques which was reinforced 1 month later by telephone
      • Control group (n=972) received standard care
    • On re-admission, delay (in seeking help) time was significantly lower in the intervention group.
    • Intervention group reported their symptoms more promptly to another person and fewer consulted a general practitioner.
    • No increase in appropriate ambulance use after intervention.
    • No increase in prescribed nitrate use use after intervention.

    Limitations

    • 96% of the sample were Irish – findings from this study may not be suitable to generalise to individuals from other cultures.
    • Follow-up period of a maximum of 2 years was relatively short.
    • Patients who were hemodynamically unstable were excluded, potentially excluding a large proportion of ACS patients.
    • Limited information on the 2% of patients who died during the study.
    • Study was conducted in five urban hospitals with widespread ambulance cover, results not applicable to rural populations with fewer ambulance service resources.
     
    Mooney M1, McKee G1, Fealy G2, O' Brien F1, O'Donnell S1, Moser D3. A Randomized Controlled Trial to Reduce Prehospital Delay Time in Patients With Acute Coronary Syndrome (ACS). J Emerg Med. 2014 Jan 8. PMID: 24411656.

     

    Abstract

    Background

    The literature suggests that people delay too long prior to attending emergency departments with acute coronary syndrome (ACS) symptoms. This delay is referred to as prehospital delay. Patient decision delay contributes most significantly to prehospital delay.

    Objectives

    Using a randomized controlled trial, we tested an educational intervention to reduce patient prehospital delay in ACS and promote appropriate responses to symptoms.

    Methods

    Eligible patients who were admitted across five emergency departments (EDs) in Dublin were recruited to the study (n = 1944; control: 972, intervention: 972).

    Results

    Median baseline prehospital delay times did not differ significantly between the groups at baseline (Mann-Whitney U, p = 0.34) (Control: 4.28 h, 25(th) percentile = 1.71, 75(th) percentile = 17.37; Intervention 3.96 h, 25(th) percentile = 1.53, 75(th) percentile = 18.51). Both groups received usual in-hospital care. In addition, patients randomized to the intervention group received a 40-min individualized education session using motivational techniques. This was reinforced 1 month later by telephone. Of the 1944, 314 (16.2%) were readmitted with ACS symptoms: 177 (18.2%) and 137 (14.1%) of the intervention and control groups, respectively. Prehospital delay times were again measured. Median delay time was significantly lower in the intervention compared to the control group (1.7 h vs. 7.1 h; p ≤ 0.001). Appropriately, those in the intervention group reported their symptoms more promptly to another person (p = 0.01) and fewer consulted a general practitioner (p = 0.02). There was no significant difference in ambulance use (p = 0.51) or nitrate use (p = 0.06) between the groups.

    Conclusions

    It is possible to reduce prehospital delay time in ACS, but the need for renewed emphasis on ambulance use is important.

    References

     
    1.

    Mooney M1, McKee G1, Fealy G2, O’ Brien F1, O’Donnell S1, Moser D3. A Randomized Controlled Trial to Reduce Prehospital Delay Time in Patients With Acute Coronary Syndrome (ACS). J Emerg Med. 2014 Jan 8. PMID: 24411656.

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    Alan Batt

    Alan Batt

    Paramedic, educator, researcher
    Alan is a critical care paramedic, paramedic educator and prehospital researcher, currently working around the world as an educator and researcher. He has previously worked and studied across Europe, North America and the Middle East. He holds a Graduate Certificate in Intensive Care Paramedic Studies, and an MSc in Critical Care. His main interests are in care of the elderly, end-of-life care, patient safety, professionalism (including role and identity), and paramedic education.

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