A randomized controlled trial to reduce prehospital delay time in patients with acute coronary syndrome (ACS)

Mooney, Mary, McKee, Gabrielle, Fealy, Gerard, O'Brien, Frances, O'Donnell, Sharon and Moser, Debra (2014) A randomized controlled trial to reduce prehospital delay time in patients with acute coronary syndrome (ACS). The Journal of Emergency Medicine, 46 4: 495-506. doi:10.1016/j.jemermed.2013.08.114

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Author Mooney, Mary
McKee, Gabrielle
Fealy, Gerard
O'Brien, Frances
O'Donnell, Sharon
Moser, Debra
Title A randomized controlled trial to reduce prehospital delay time in patients with acute coronary syndrome (ACS)
Journal name The Journal of Emergency Medicine   Check publisher's open access policy
ISSN 0736-4679
Publication date 2014-04-01
Year available 2014
Sub-type Article (original research)
DOI 10.1016/j.jemermed.2013.08.114
Open Access Status Not yet assessed
Volume 46
Issue 4
Start page 495
End page 506
Total pages 12
Place of publication Philadelphia, United States
Publisher Elsevier
Language eng
Formatted 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, 25th percentile = 1.71, 75th percentile = 17.37; Intervention 3.96 h, 25th percentile = 1.53, 75th 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.

Conclusion It is possible to reduce prehospital delay time in ACS, but the need for renewed emphasis on ambulance use is important.
Keyword Randomized controlled trial
Acute coronary syndrome
Prehospital delay time
Educational intervention
Behavioral change
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Nursing, Midwifery and Social Work Publications
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Created: Tue, 06 May 2014, 19:24:38 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work