Education on prompt treatment fails to reduce hospital delays in ACS
MedWire News: Educating and counseling patients with coronary heart disease on the signs and symptoms of acute coronary syndrome (ACS) and the importance of seeking treatment quickly does not reduce delays in hospital admission or increase ambulance use, study findings show.
“Delay in contacting the health care system in the face of cardiac symptoms remains a major obstacle to definitive treatment of patients with acute myocardial infarction and may contribute to out-of-hospital cardiac deaths,” note Kathleen Dracup (University of California, San Francisco, USA) and colleagues.
They hoped that a relatively short, one-on-one education and counseling intervention would prompt patients who experience the signs and symptoms of ACS to seek help quickly.
The team randomly assigned 3522 patients (68% male) with documented coronary heart disease, aged an average of 67 years, to receive the intervention or make up the usual care control group.
The intervention gave standardized information on the typical and atypical symptoms of ACS and emphasized the rewards of seeking treatment immediately by calling for an ambulance.
Analysis of data on 3087 patients who completed 2 years of follow-up showed that 565 (16%) were admitted to an emergency department with ACS symptoms a total of 842 times. Of these emergency department admissions, 408 (48%) were in the control group and 434 (53%) were in the intervention group.
The researchers report in the journal Circulation: Cardiovascular Quality and Outcomes that the delay in getting to hospital was similar for the two groups, at 2.20 hours for patients receiving the intervention and 2.25 hours for controls.
Patients receiving the intervention was also no more likely than controls to call the emergency medical services, at 63.6% and 66.9%, respectively.
Dracup and colleagues note, however, that patients receiving the education intervention were more likely than controls to take aspirin after symptom onset, at 22.3% versus 10.1%, respectively.
They were also more likely to call the emergency medical services if their symptoms occurred within the first 6 months of receiving the intervention.
The researchers therefore suggest that “repetition of the information might increase the saliency of the intervention.”
Given the negative findings, Dracup et al conclude that “further research is required to determine how best to encourage patients who experience symptoms of ACS to seek care promptly.”
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By Lucy Piper