Search

The purpose of this study was to test the effectiveness of a 'Heart Attack Survival Kit', disseminated via two different delivery methods, designed to increase seniors' intentions to call 911 and take an aspirin in response to a cardiac emergency. Twelve-hundred seniors were randomly assigned to (1) receiving a Kit via a home visit by an Emergency Medical Technician (EMT), (2) receiving a Kit via direct mail or (3) a control group. All participants were telephoned and asked how they would respond to a cardiac emergency. Results showed that respondents in the intervention group (EMT and direct mail group combined) reported a greater frequency of the recommended coping response to AMI (39%) than respondents in the control group (10%) (P < 0.000). Within intervention groups, 47% in the EMT group and 30% in the direct mail group (P < 0.000) reported intentions to take the appropriate response to AMI. The results suggest that a Heart Attack Survival Kit, especially when delivered door-to-door by EMTs, can be an effective way of educating seniors about cardiac emergencies.

Study objective: To determine the reasons patients with suspected acute myocardial infarction (AMI) delay seeking medical care or do not call 911. Design: Telephone interview of patients hospitalized with suspected AMI. Setting: Nine hospitals in King County, Washington. Participants: Patients admitted to a CCU or ICU between October 1, 1986, and December 31, 1987, with suspected AMI occurring out-of-hospital. Spouses of patients who met criteria but died during the hospitalization also participated. Interventions: Hospital records were reviewed, and a 20-minute telephone interview was conducted of patients who reside in King County but do not live in an extended care facility. Measurements: Patient demographics, cardiac history, symptoms, time of acute symptom onset, time of emergency department arrival, method of transportation, discharge diagnosis, and hospital outcome were abstracted from hospital records. Circumstances leading to the hospitalization, reasons for delay in seeking care, and reasons for not calling 911 were determined in the telephone interview. Results: In a 15-month period, 5,207 patients were hospitalized for suspected AMI in King County, Washington. Twenty-seven percent had AMI. Median patient delay between symptom onset and hospital arrival was 2 hours. Paramedics transported 45% of all patients. A representative subset of patients (2,316) were interviewed. The main reasons for delay were because the patient thought that the symptoms would go away, because the symptoms were not severe enough, and because the patient thought that the symptoms were caused by another illness. The main reasons for not calling 911 were because the symptoms were not severe enough, because the patient did not think of calling 911, and because the patient thought that self-transport would be faster because of his or her close location to the hospital. Conclusion: Maximal benefit from thrombolytic therapy is not realized in a substantial proportion of patients with AMI because of delays in seeking medical care. Knowledge of the reasons patients delay or do not call 911 can help focus efforts on achieving more rapid treatment of patients with AMI. [Meischke H, Ho MT, Eisenberg MS, Schaeffer SM, Larsen MP: Reasons patients with chest pain delay or do not call 911. Ann Emerg Med February 1995;25:193-197.]

Since 1988, 641 black and 11,892 white patients with chest pain of presumed cardiac origin have been admitted to coronary care units in 19 hospitals in metropolitan Seattle. Black men and women were younger (58 vs 66, p less than 0.0001), more often admitted to central city hospitals (p less than 0.0001), and developed evidence of acute myocardial infarction (AMI) less often (19 vs 23%, p = 0.01). In the subset of 2,870 AMI patients, blacks (n = 121) were younger (59 vs 67, p less than 0.0001) and had less prior coronary artery bypass graft surgery (2 vs 10%, p = 0.005) and more prior hypertension (67 vs 46%, p less than 0.0001). During hospitalization, whites (n = 2,749) had higher rates of coronary angioplasty (18 vs 10%, p = 0.03) and coronary artery bypass graft surgery (10 vs 4%, p = 0.04), although thrombolytic therapy and cardiac catheterization were used equally in the 2 groups. Hospital mortality was 7.4% for black and 13.1% for white patients (p = 0.07). However, after adjustment for key demographic and clinical variables by logistic regression, this difference was not as apparent (p = 0.38). Questions about the premature onset of coronary artery disease, excess systemic hypertension, and the differential use of interventions in black persons have been raised by other investigators. Despite differences in age, referral patterns and the use of coronary angioplasty and bypass surgery, black and white patients with AMI in metropolitan Seattle had similar outcomes.

Thrombolytic therapy for acute myocardial infarction (AMI) is now routinely given in the emergency department and is being considered for pre-hospital care. Its effectiveness is dependent on how early it can be given after the onset of AMI. Maximal benefit, however, is not realized in many patients due to delay in seeking care. The effect of a public media education campaign (message) to shorten patient delay and increase use of emergency medical services (EMS) was evaluated prospectively in King County, Washington. We interviewed 401 patients admitted with possible AMI in the premessage period (4.5 months) and 489 in the postmessage period (4.5 months). The two groups were comparable in all factors except for discharge diagnosis of AMI (premessage, 34%; postmessage, 25%; P less than .01) and history of myocardial infarction or angina (premessage, 52%; postmessage, 43%; P less than .01). The proportion of patients who heard new information on AMI increased significantly in the postmessage period (premessage, 53%; postmessage, 74%; P less than .0001). The campaign, however, did not significantly shorten patient delay in seeking care (median delay: premessage, 2.6 hours; postmessage, 2.3 hours) or alter the distribution of patients in the less-than-two-hour, two-to-four-hour, and more-than-four-hour intervals. The rate of EMS use also was not significantly changed (premessage, 42%; postmessage, 44%). We conclude that a short-duration education campaign may increase AMI knowledge but does not seem to significantly alter patient behavior.