Objectives

This multicenter controlled community study developed and evaluated the impact of a community educational intervention program on patient delay time from onset of symptoms of an AMI to arrival at a hospital emergency department.

Background

Although early reperfusion or thrombolytic therapy can reduce morbidity and mortality following an acute myocardial infarction (AMI), delayed access to medical care in patients is relatively common. Mean delay times from symptom onset to hospital arrival range from more than 4 hours to 24 hours, and the largest component of prolonged delay is patient recognition and action.

Participants

A total of 20 Communities from 5 field centers in the U.S. were pair-matched (10 pairs) according to geographic proximity and demographic characteristics. After initiation of a 4 month baseline surveillance period one community in each pair was randomly selected to receive the intervention. The baseline surveillance period was followed by an 18 month community intervention and surveillance period. The community surveillance captured a total of 59,944 adults aged 30 years or older presenting to hospital emergency departments with chest pain, of whom 20,364 met study criteria for suspected acute coronary heart disease (CHD) at admission and discharged with a CHD diagnosis.

Conclusions

Delay times were decreased in the intervention and reference communities. The results showed that the multicomponent community intervention program did not differentially reduce delay time from onset of acute MI symptoms to arrival at a hospital, but did significantly increase the use of Emergency Medical Services by these patients in the intervention communities. (JAMA 2000;284:60-67).

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