Simple educational initiative dramatically reduces pre-hospital delay for patients with heart attack / angina

May 2, 2014 by Yolanda Kennedy

(Medical Xpress)—A new study, recently published in the leading international peer reviewed journal, The Journal of Emergency Medicine, has shown how a simple, individualised 40- minute educational session dramatically improved the amount of time it took patients who experienced symptoms of acute coronary syndrome (ACS) to present to the emergency department. Acute coronary syndrome includes heart attack and unstable angina.

The study by academics from the School of Nursing and Midwifery, Trinity College Dublin, took place over three years in five major Dublin hospitals. The study involved patients who were diagnosed with and were then readmitted to an Emergency Department with unresolved ACS symptoms within the study period.

The patients who received the specially designed 40-minute educational session, on later re-admission presented much faster (within 1.7 hours) to a hospital Emergency Department, compared to those who didn't receive the educational intervention (within 7.1 hours).

This represents a 62% improvement among the patients who received the educational intervention, compared to the first time they presented with acute coronary syndrome. Conversely, and interestingly, for those who did not receive the intervention, it took them almost one third longer to get to the hospital Emergency Department, compared to their first admission time.

Speaking about the significance of the study, which was funded by the Health Research Board, Assistant Professor and lecturer, Mary Mooney from the School of Nursing and Midwifery, Trinity College Dublin, said: "Individuals who survive acute coronary syndrome events are more likely to sustain further events in the future. Early hospitalisation is crucial to optimise diagnosis and management of these events. Patients who are experiencing a should receive life-saving medical treatment as quickly as possible, and ideally within one hour of symptom onset. An individualised educational intervention, such as the one given in this study, can significantly reduce pre-hospital delay time which can in turn reduce mortality and morbidity".

Speaking about patient delay, Ms Mooney said: "There are many reasons why patients delay going to the Emergency Department when they experience acute coronary syndrome symptoms. Through behavioural change and motivational techniques, the educational session helped the patients to focus on and deal with some of those reasons and develop an action plan for what they would do should they experience symptoms again. The educational intervention is short, focused and cost effective with clear benefits. It could be incorporated into usual care in the future."

This is the first randomised controlled trial to report a significant reduction in pre-hospital delay time among patients diagnosed with acute coronary syndrome and the first of its kind to measure pre-hospital delay times in the same patients prior to and after the intervention.

Common reasons why people may delay going straight to an emergency department when they have acute coronary syndrome symptoms:

  • Not recognising the signs and symptoms of a heart attack. Many people assume that the symptoms are always like you see in Hollywood movies – clutching the chest and collapsing. However, sometimes the symptoms are subtle, slow onset, intermittent and atypical. This was demonstrated recently in another JEM article published by the same group of researchers who reported that 'slow-onset' heart attack symptoms directly contribute to delay in accessing emergency treatment and that 65% of patients in the study experienced 'slow-onset' ACS;
  • Emotional responses to symptoms such as denial or fear;
  • Misconceptions about the ability of a GP to treat a heart attack;
  • Lack of knowledge about the importance of using an ambulance.

Things to remember if you have been diagnosed with Acute Coronary Syndrome:

  • Acute coronary syndrome includes angina and a heart attack. Angina can be relieved by taking the prescribed medication. However, if it is unresolved after this, it needs attention and may reflect acute coronary syndrome.
  • The symptoms of acute coronary syndrome can present in a range of ways and can vary between individuals. The symptoms that you experience on one occasion may differ from those experienced on another occasion. Some, but not all people will have typical symptoms of chest pain, pressure or tightness. There are many other symptoms for example, discomfort or heaviness in one or both arms, indigestion, nausea or pain between the shoulder blades.
  • Early presentation at hospital can determine if the unresolved symptoms are indicative of an acute coronary syndrome event. This will facilitate early treatment can save heart muscle and prevent or reduce the complications of a heart attack.
  • If you have unresolved acute coronary syndrome : you should
  • Stop and rest;
  • Tell someone what is happening;
  • Take prescribed nitrates, if available and;
  • Phone 999 or 112 for an ambulance to take you to the ;
  • Do not wait to phone or visit your GP.
  • If in doubt, let the emergency department check it out!!

Explore further: New study shows 'slow-onset' heart attack symptoms directly contribute to delay in accessing emergency treatment

More information: The full study by Mooney et al. is available online: www.sciencedirect.com/science/ … ii/S0736467913011074

Related Stories

New study shows 'slow-onset' heart attack symptoms directly contribute to delay in accessing emergency treatment

November 13, 2013
A major new Irish study carried out by researchers at the School of Nursing and Midwifery, Trinity College Dublin and recently published in the leading international peer reviewed journal, the Journal of Emergency Medicine ...

Heart CT scans may help emergency room personnel more quickly assess patients with chest pain

July 25, 2012
Adding computed tomography (CT) scans to standard screening procedures may help emergency room staff more rapidly determine which patients complaining of chest pain are having a heart attack or may soon have a heart attack, ...

New method quickly determines if chest pain is acute coronary syndrome

November 5, 2013
Researchers at Karolinska Institutet have tested a new method for quickly ruling out acute myocardial infarction or other serious acute coronary disease in emergency department patients complaining of chest pains. The method, ...

Uric acid levels predict death in acute coronary syndrome

April 20, 2012
(HealthDay) -- Elevated uric acid levels are predictive of one-year mortality in patients with acute coronary syndrome, according to a study published in the May 1 issue of The American Journal of Cardiology.

Study finds Irish people slow to go to hospital with heart attack symptoms

May 1, 2013
(Medical Xpress)—Patient behaviour is one of the biggest causes of delay in getting to hospital when suffering a heart attack according to the findings of a new HRB-funded study at Trinity College Dublin. The delay is ...

Not all acute coronary syndrome patients get appropriate tx

February 26, 2014
(HealthDay)—Nearly one in five eligible patients hospitalized for acute coronary syndrome do not receive American College of Cardiology/American Heart Association (ACC/AHA) class I guideline-recommended angiotensin-converting ...

Recommended for you

Could aggressive blood pressure treatments lead to kidney damage?

July 18, 2017
Aggressive combination treatments for high blood pressure that are intended to protect the kidneys may actually be damaging the organs, new research from the University of Virginia School of Medicine suggests.

Quantifying effectiveness of treatment for irregular heartbeat

July 17, 2017
In a small proof-of-concept study, researchers at Johns Hopkins report a complex mathematical method to measure electrical communications within the heart can successfully predict the effectiveness of catheter ablation, the ...

Concerns over side effects of statins stopping stroke survivors taking medication

July 17, 2017
Negative media coverage of the side effects associated with taking statins, and patients' own experiences of taking the drugs, are among the reasons cited by stroke survivors and their carers for stopping taking potentially ...

Study discovers anticoagulant drugs are being prescribed against safety advice

July 17, 2017
A study by researchers at the University of Birmingham has shown that GPs are prescribing anticoagulants to patients with an irregular heartbeat against official safety advice.

Protein may protect against heart attack

July 14, 2017
DDK3 could be used as a new therapy to stop the build-up of fatty material inside the arteries

Heart study finds faulty link between biomarkers and clinical outcomes

July 14, 2017
Surrogate endpoints (biomarkers), which are routinely used in clinical research to test new drugs, should not be trusted as the ultimate measure to approve new health interventions in cardiovascular medicine, according to ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.