title: A review of interventions aimed at reducing pre-hospital delay time in acute coronary syndrome: what has worked and why?
abstract: BACKGROUND
  Delay in seeking treatment for acute coronary syndrome (ACS) symptoms is a well recognised problem. While the factors that influence pre-hospital delay have been well researched, to date this information alone has been insufficient in altering delay behaviour.
  
  
  OBJECTIVE
  This paper reports the results of a critical appraisal of previously tested interventions designed to reduce pre-hospital delay in seeking treatment for ACS symptoms.
  
  
  METHODS
  The search was confined to interventions published between 1986 and the present that were written in English and aimed at reducing pre-hospital delay time. The following databases were searched using keywords: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Pubmed, Academic Search Premier, Ovid, Cochrane, British Nursing Index, and Google Scholar. A total of eight intervention studies were identified as relevant. This review was developed following a systematic comparative analysis of those eight studies.
  
  
  RESULTS
  Seven of the eight interventions were based on mass media campaigns. One campaign was targeted at individuals. All were aimed at raising ACS symptom awareness and/or increasing prompt action in the presence of symptoms. Only two studies reported a statistically significant reduction in pre-hospital delay time.
  
  
  CONCLUSIONS
  In response to concerns about prolonged pre-hospital delay time in ACS, interventions targeting the problem have been developed. The literature indicates that responses to symptoms depend on a variety of factors. In light of this, interventions should include the scope of factors that can potentially influence pre-hospital delay time and ideally target those who are at greatest risk of an ACS event.
authors.affiliation: School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland. mooneym4@tcd.ie
authors.forename: Mary
authors.initials: M
authors.lastname: Mooney
authors.forename: Gabrielle
authors.initials: G
authors.lastname: McKee
authors.forename: Gerard
authors.initials: G
authors.lastname: Fealy
authors.forename: Frances
authors.initials: F
authors.lastname: O'Brien
authors.forename: Sharon
authors.initials: S
authors.lastname: O'Donnell
authors.forename: Debra
authors.initials: D
authors.lastname: Moser
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007494:Ireland; D008875:Middle Aged; D020380:Needs Assessment; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000458:organization & administration*; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors