Systematic review of interventions to reduce delay in patients with suspected heart attack

Abstract

Objectives: To evaluate the effectiveness of interventions aiming to reduce time from onset of signs and symptoms of an acute myocardial infarction (AMI) to seeking medical help/arrival at hospital. Methods: A systematic review was conducted. Fifteen electronic databases, the internet, and bibliographies of included studies were searched, and experts in the field of cardiac care were contacted. Randomised controlled trials (RCTs), controlled trials, and before and after studies conducted in any setting that assessed an intervention aimed at reducing time from onset of signs and symptoms of an AMI to seeking medical help and/or arrival in hospital were eligible for inclusion. Results: Eleven media/public education intervention studies met the inclusion criteria. Five (one controlled and four before and after studies) reported the intervention to have a statistically positive effect on delay time and six (two RCTs and four before and after studies) reported no statistically significant effect. Three (one RCT and two before and after studies) of five studies evaluating the effect of the intervention on emergency department visits reported an increase in this outcome as a result of the intervention, and both studies (one RCT and one before and after study) examining calls made to emergency switchboards reported an increase in this outcome after the intervention. Conclusions: There was little evidence that media/public education interventions reduced delay. There is some evidence that they may result in an increase in emergency switchboard calls and emergency department visits. Despite substantial expenditure of time and effort, methodological deficiencies of the studies mean that it is not possible to make definitive recommendations.

Sex and age specific time patterns and long term time trends of pre-hospital delay of patients presenting with acute ST-segment elevation myocardial infarction

“…Trend analyses revealed no or no compelling decline over the years under observation. To date, population-based interventions have not been particularly successful [34]. Thus, maintaining a sense of realism, the reduction of median PHDT from 163 min to 120 min area appears to be a realistic and achievable public health aim for this particular population.…”

Predictors of pre-hospital delay among patients with acute myocardial infarction

“…Based on the understanding of predictors of pre-hospital delay, it is important to implement interventions that focus on the importance of early symptom recognition and prompt care seeking. In doing so, it should be recognized that mass community education programs designed to educate the public about the importance of responding quickly to acute coronary events did not produce encouraging results [56,57]. Kainth et al explained that lack of success of public campaigns is due to utilizing poor methodological approaches.…”

“…Kainth et al explained that lack of success of public campaigns is due to utilizing poor methodological approaches. The authors maintained that it is useful to assess the decision-making process to call for help that patients and their family use before advocating interventions [57]. Alonzo and Reynolds reported that educating the public is a complex process due to various socio-psychological difficulties [58].…”

Lay public’s knowledge and decisions in response to symptoms of acute myocardial infarction

“…Unfortunately, even though these programs have had some success, they have not had the anticipated results in terms of substantial, widespread, and long-lasting reduction in the latency between the onset of symptoms and receiving treatment (Kainth et al 2004). …”