REACT theory-based intervention to reduce treatment-seeking delay for acute myocardial infarction

Raczynski, James M.; Finnegan, John R.; Zapka, Jane G.; Meischke, Hendricka; Meshack, Angela; Stone, Elaine J.; Bracht, Neil F.; Sellers, Deborah E.; Daya, Mohamud; Robbins, Mark L.; McAlister, Alfred L.; Simons‐Morton, Denise G.

doi:10.1016/s0749-3797(99)00023-9

Cited by 39 publications

(45 citation statements)

References 50 publications

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“…38 The patient's activity level at symptom onset is another situational factor: those resting or sleeping at symptom onset delay longer than those engaging in physical activity. 38 As might be expected, long travel distances to the hospital, 59 rural residence, 82 and traveling home in response to symptoms are all associated with longer delays. 16,38,84 Living alone 84 and being alone at symptom onset 82 are associated with longer delays in seeking care for ACS symptoms.…”

Section: Social Cognitive and Emotional Factorsmentioning

confidence: 93%

“…38 As might be expected, long travel distances to the hospital, 59 rural residence, 82 and traveling home in response to symptoms are all associated with longer delays. 16,38,84 Living alone 84 and being alone at symptom onset 82 are associated with longer delays in seeking care for ACS symptoms. Although being alone and at home at acute symptom onset increases delay, 83 the vast majority of individuals are with someone when symptoms begin.…”

Section: Social Cognitive and Emotional Factorsmentioning

confidence: 93%

“…One of the earliest studies on patient delay in seeking treatment during AMI incorporated both cognitive and emotional variables, 81,82 but research in the 3 decades since this study was published has included these factors only sporadically.…”

Section: Social Cognitive and Emotional Factorsmentioning

confidence: 99%

“…83 Being with a companion promotes faster care seeking. 82 The fastest response times are found in those who are with a coworker or a companion who is not a family member when symptoms begin. 56,85 Family members (particularly spouses) often recommend strategies that increase delay.…”

Section: Social Cognitive and Emotional Factorsmentioning

confidence: 99%

“…When patients wait for symptoms to go away 82 or wait for them to evolve into a highly recognizable pattern, substantial delay in seeking treatment occurs. Taking medications 42,54 and other self-care strategies, very common with ACS symptoms, result in delays in seeking care.…”

Section: Social Cognitive and Emotional Factorsmentioning

confidence: 99%

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Reducing Delay in Seeking Treatment by Patients With Acute Coronary Syndrome and Stroke

Moser¹,

et al. 2006

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Abstract-Patient delay in seeking treatment for acute coronary syndrome and stroke symptoms is the major factor limiting delivery of definitive treatment in these conditions. Despite decades of research and public education campaigns aimed at decreasing patient delay times, most patients still do not seek treatment in a timely manner. In this scientific statement, we summarize the evidence that (1) demonstrates the benefits of early treatment, (2) describes the extent of the problem of patient delay, (3) identifies the factors related to patient delay in seeking timely treatment, and (4) reveals the inadequacies of our current approaches to decreasing patient delay. Finally, we offer suggestions for clinical practice and future research. Key Words: AHA Scientific Statements Ⅲ acute coronary syndrome Ⅲ stroke Ⅲ delivery of health care D espite major advances in identifying effective treatments for heart attack and stroke, there are substantial difficulties in applying these treatments to care. The weak link in the chain of events leading to prompt and effective treatment is patient delay in seeking care. More than 50% of the 1.2 million people who suffer an acute myocardial infarction (AMI) or coronary death each year in the United States die in an emergency department (ED) or before reaching a hospital within an hour of symptom onset. 1 About 700 000 individuals will have a stroke each year, 167 000 of those who have strokes will die, and more will suffer a major disability. 1 Of the stroke deaths that occur each year, almost half occur before the patient reaches the hospital. 2 Many of these deaths and significant disability could be prevented if patients received earlier treatment. 1,3 Although the benefits of early treatment of heart attack and stroke are clear, only a minority of eligible patients receive optimally timed treatment for their symptoms because of delay in seeking care. The development and use of appropriate interventions to decrease treatment-seeking delay by patients could produce important gains in reducing death and disability from heart attack and stroke. Unfortunately, efforts to date to develop effective interventions have met with disappointing results. 4 -6 Accordingly, the purpose of this statement is to summarize the evidence that demonstrates the benefits of early treatment, 1,2 describes the extent of the problem of patient delay, 3 identifies the factors related to patient delay in seeking timely treatment, and reveals the inadequacies of our current approaches to decreasing patient delay. 4 Finally, we offer suggestions for clinical practice and future research. Benefits of Early TreatmentThe burden of cardiovascular disease is growing worldwide. Ischemic heart disease is the No. 1 cause of death in the The findings and conclusions in this scientific statement are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention and the National Heart, Lung, and Blood Institute.The American Heart Association makes every effort to av...

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Section: Social Cognitive and Emotional Factorsmentioning

confidence: 93%

Section: Social Cognitive and Emotional Factorsmentioning

confidence: 93%

Section: Social Cognitive and Emotional Factorsmentioning

confidence: 99%

Section: Social Cognitive and Emotional Factorsmentioning

confidence: 99%

Section: Social Cognitive and Emotional Factorsmentioning

confidence: 99%

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Reducing Delay in Seeking Treatment by Patients With Acute Coronary Syndrome and Stroke

Moser¹,

et al. 2006

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Effect of a Community Intervention on Patient Delay and Emergency Medical Service Use in Acute Coronary Heart Disease

Luepker

Raczynski²,

Osganian

et al. 2000

JAMA

468

371

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In this study, despite an 18-month intervention, time from symptom onset to hospital arrival for patients with chest pain did not change differentially between groups, although increased appropriate EMS use occurred in intervention communities. New strategies are needed if delay time from symptom onset to hospital presentation is to be decreased further in patients with suspected AMI. JAMA. 2000;284:60-67

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Effects of a Narrative-Based Psychoeducational Intervention to Prepare Patients for Responding to Acute Myocardial Infarction

Yan

et al. 2022

JAMA Netw Open

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ImportanceDespite decades of educational efforts, patients’ prolonged delays in seeking care for symptoms of acute myocardial infarction (AMI) remain the greatest obstacle to successful management of the condition.ObjectiveTo compare the effects of a narrative-based psychoeducational intervention with a didactic educative approach on AMI survivors’ intention to seek care for AMI symptoms and on AMI knowledge.Design, Setting, and ParticipantsA multisite randomized clinical trial recruited community-dwelling patients aged 18 years or older with a history of AMI from 4 hospitals in Hong Kong from January 1, 2018, to January 22, 2021, and followed up participants for 1 year.InterventionsAn 8-week narrative-based psychoeducational intervention aimed to create a vivid cognitive experience of complex decision-making and modeled desirable behavioral changes through nurse-led, interactive video sessions using model patients. The control group received 4 nurse-led sessions comprising education about AMI and care seeking delivered using a didactic approach.Main Outcomes and MeasuresThe primary outcome was the behavioral intention between the 2 groups, reflected by participants’ attitudes and beliefs about care seeking for AMI measured using the Acute Coronary Syndrome Response Index—Chinese version. The secondary outcome was AMI knowledge.ResultsSix hundred and eight participants (mean [SD] age, 67.2 [8.3] years; 469 [77.1%] male) were randomized to either the narrative-based psychoeducation group (n = 304) or the didactic education group (n = 304). The psychoeducational intervention group reported greater positive changes than the control group in their attitudes (β = −1.053 [95% CI, −1.714 to −0.391]; P &lt; .001) and beliefs (β = −0.686 [95% CI, −1.354 to −0.180]; P = .04) toward care seeking at the 3-month follow-up, and the difference was sustained at 12 months for both attitudes (β = −0.797 [95% CI, −1.477 to −0.117]; P = .02) and beliefs (β = −0.692 [95% CI, −1.309 to −0.012]; P = .047). There were no significant differences in AMI knowledge between the 2 study groups at the 3-month and 12-month time points.Conclusions and RelevanceThe results of this randomized clinical trial found that a novel approach of narrative-based psychoeducation was effective in improving patients’ behavioral intention to seek care for AMI symptoms. Longer-term follow-up to evaluate actual care-seeking behavior and clinical outcomes in patients with AMI is warranted to determine the sustained effects of this intervention.Trial RegistrationChiCTR Identifier: ChiCTR-IIC-17010576

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REACT theory-based intervention to reduce treatment-seeking delay for acute myocardial infarction

Cited by 39 publications

References 50 publications

Reducing Delay in Seeking Treatment by Patients With Acute Coronary Syndrome and Stroke

Reducing Delay in Seeking Treatment by Patients With Acute Coronary Syndrome and Stroke

Effect of a Community Intervention on Patient Delay and Emergency Medical Service Use in Acute Coronary Heart Disease

Effects of a Narrative-Based Psychoeducational Intervention to Prepare Patients for Responding to Acute Myocardial Infarction

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