title: A randomized controlled trial to reduce prehospital delay time in patients with acute coronary syndrome (ACS).
abstract: BACKGROUND
  The literature suggests that people delay too long prior to attending emergency departments with acute coronary syndrome (ACS) symptoms. This delay is referred to as prehospital delay. Patient decision delay contributes most significantly to prehospital delay.
  
  
  OBJECTIVE
  Using a randomized controlled trial, we tested an educational intervention to reduce patient prehospital delay in ACS and promote appropriate responses to symptoms.
  
  
  METHODS
  Eligible patients who were admitted across five emergency departments (EDs) in Dublin were recruited to the study (n = 1944; control: 972, intervention: 972).
  
  
  RESULTS
  Median baseline prehospital delay times did not differ significantly between the groups at baseline (Mann-Whitney U, p = 0.34) (CONTROL: 4.28 h, 25(th) percentile = 1.71, 75(th) percentile = 17.37; Intervention 3.96 h, 25(th) percentile = 1.53, 75(th) percentile = 18.51). Both groups received usual in-hospital care. In addition, patients randomized to the intervention group received a 40-min individualized education session using motivational techniques. This was reinforced 1 month later by telephone. Of the 1944, 314 (16.2%) were readmitted with ACS symptoms: 177 (18.2%) and 137 (14.1%) of the intervention and control groups, respectively. Prehospital delay times were again measured. Median delay time was significantly lower in the intervention compared to the control group (1.7 h vs. 7.1 h; p ≤ 0.001). Appropriately, those in the intervention group reported their symptoms more promptly to another person (p = 0.01) and fewer consulted a general practitioner (p = 0.02). There was no significant difference in ambulance use (p = 0.51) or nitrate use (p = 0.06) between the groups.
  
  
  CONCLUSIONS
  It is possible to reduce prehospital delay time in ACS, but the need for renewed emphasis on ambulance use is important.
authors.affiliation: School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
authors.forename: Mary
authors.initials: M
authors.lastname: Mooney
authors.affiliation: School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: McKee
authors.affiliation: School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, Ireland.
authors.forename: Gerard
authors.initials: G
authors.lastname: Fealy
authors.affiliation: School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
authors.forename: Frances
authors.initials: F
authors.lastname: O' Brien
authors.affiliation: School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
authors.forename: Sharon
authors.initials: S
authors.lastname: O'Donnell
authors.affiliation: College of Nursing, University of Kentucky, Lexington, Kentucky.
authors.forename: Debra
authors.initials: D
authors.lastname: Moser
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000368:Aged; D000552:Ambulances / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D009566:Nitrates / Q000627:therapeutic use; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D010359:Patient Readmission; D012008:Recurrence; D061665:Time-to-Treatment
chemical_list: D009566:Nitrates
keywords: acute coronary syndrome; behavioral change; educational intervention; prehospital delay time; randomized controlled trial