title: Who listens to our advice? A secondary analysis of data from a clinical trial testing an intervention designed to decrease delay in seeking treatment for acute coronary syndrome.
abstract: OBJECTIVE
  Prolonged prehospital delay in persons experiencing acute coronary syndrome (ACS) remains a problem. Understanding which patients respond best to particular interventions designed to decrease delay time would provide mechanistic insights into the process by which interventions work.
  
  
  METHODS
  In the PROMOTION trial, 3522 at-risk patients were enrolled from 5 sites in the United States (56.4%), Australia and New Zealand; 490 (N=272 intervention, N=218 control) had an acute event within 2 years. Focusing on these 490, we (1) identified predictors of a rapid response to symptoms, (2) identified intervention group subjects with a change in these predictors over 3 months of follow-up, and (3) compared intervention group participants with and without the favorable response pattern. Hypothesized predictors of rapid response were increased perceived control and decreased anxiety. Knowledge, attitudes, and beliefs were hypothesized to differ between responders and non-responders.
  
  
  RESULTS
  Contrary to hypothesis, responders had low anxiety and low perceived control. Only 73 (26.8%) subjects showed this pattern 3 months following the intervention. No differences in ACS knowledge, attitudes, or beliefs were found.
  
  
  CONCLUSIONS
  The results of this study challenge existing beliefs.
  
  
  CONCLUSIONS
  New intervention approaches that focus on a realistic decrease in anxiety and perceived control are needed.
authors.affiliation: School of Nursing, University of Pennsylvania, Philadelphia, PA 19104-4217, USA. briegel@nursing.upenn.edu
authors.forename: Barbara
authors.initials: B
authors.lastname: Riegel
authors.forename: Angelo
authors.initials: A
authors.lastname: Elmi
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
authors.forename: Sharon
authors.initials: S
authors.lastname: McKinley
authors.forename: Hendrika
authors.initials: H
authors.lastname: Meischke
authors.forename: Lynn V
authors.initials: LV
authors.lastname: Doering
authors.forename: Patricia
authors.initials: P
authors.lastname: Davidson
authors.forename: Michele
authors.initials: M
authors.lastname: Pelter
authors.forename: Heather
authors.initials: H
authors.lastname: Baker
authors.forename: Kathleen
authors.initials: K
authors.lastname: Dracup
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D016009:Chi-Square Distribution; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010343:Patient Admission / Q000706:statistics & numerical data; D012044:Regression Analysis; D013997:Time Factors; D014481:United States