title: Impact of a nationwide public campaign on delays and outcome in Swiss patients with acute coronary syndrome.
abstract: BACKGROUND
  To improve the outcome in patients with acute coronary syndrome (ACS), public campaigns have been launched aimed at shortening presentation delays and allowing more efficient treatment. Their impact is uncertain.
  
  
  METHODS
  Pre-hospital delays and outcome in patients with ACS included in the Swiss National AMIS Plus registry were assessed prospectively before and after a nationwide multimedia campaign ('HELP') by the Swiss Heart Foundation in 2007. The campaign aimed at better awareness of symptoms, increasing knowledge in laymen of resuscitation and more rapid access to medical services. The primary study endpoint was the time between onset of symptoms and hospital admission. Secondary endpoints were successful out-of-hospital resuscitation, symptoms upon admission, and outcome.
  
  
  RESULTS
  Between January 2005 and December 2008, 8906 ACS patients (61% ST-segment elevation myocardial infarction (STEMI), 39% non-ST-segment elevation myocardial infarction/unstable angina pectoris (NSTEMI/UAP), mean age 65 ± 13 years, 75% males) admitted within 24 hours after onset of symptoms were enrolled. The median pre-hospital delay was reduced from 197 minutes during the pre-intervention period to 180 minutes during the post-intervention period (reduction 10% (95% confidence interval (CI) 6-14%); P < 0.001), in STEMI (reduction 10% (95% CI 5-14%); P < 0.001) and NSTEMI patients (reduction 11% (95% CI 4-17%); P = 0.001), due to pronounced effects in males (reduction 12% (95% CI 7-16%); P < 0.001) and in patients ≤75 years (reduction 12% (95% CI 8-16%); P < 0.001). Out-of-hospital resuscitation increased (odds ratio (OR) 1.26 (95% CI 1.06-1.54); P = 0.02). Overall outcome remained unchanged, however, the rate of re-infarction showed a decrease (OR 0.58 (95% CI 0.36-0.91); P = 0.021).
  
  
  CONCLUSIONS
  After a nationwide educational campaign, shorter pre-hospital delays were observed, and more patients were able to be treated promptly. These results may be useful in planning future health strategies to improve management and outcome of patients with ACS, especially in female and elderly patients.
authors: HerzGefässZentrum, Klinik Im Park, Seestrasse 247, Zürich, Switzerland. barbara.naegeli@hirslanden.ch
authors: Barbara
authors: B
authors: Naegeli
authors: Dragana
authors: D
authors: Radovanovic
authors: Hans
authors: H
authors: Rickli
authors: Paul
authors: P
authors: Erne
authors: Burkhardt
authors: B
authors: Seifert
authors: Nicole
authors: N
authors: Duvoisin
authors: Giovanni
authors: G
authors: Pedrazzini
authors: Philip
authors: P
authors: Urban
authors: Osmund
authors: O
authors: Bertel
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000367:Age Factors; D000368:Aged; D001364:Awareness; D016887:Cardiopulmonary Resuscitation; D016009:Chi-Square Distribution; D004632:Emergency Medical Services; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006297:Health Services Accessibility; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D010343:Patient Admission; D015397:Program Evaluation; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000209:etiology; D013557:Switzerland; D013997:Time Factors; D014187:Transportation of Patients; D016896:Treatment Outcome