Russell V. Luepker

An evaluation of the results of media and educational campaigns designed to shorten the time taken by patients with acute myocardial infarction to decide to go to hospital.

OBJECTIVE: To describe the benefits and pitfalls of educational campaigns designed to reduce the delay between the onset of acute myocardial infarction (AMI) and its treatment. METHODS: All seven educational campaigns reported between 1982 and 1994 were evaluated. RESULTS: The impact on delay time ranged from a reduction of patient decision time by 35% to no reduction. One study reported a sustained reduction that resulted in the delay time being halved during the three years after the campaign. The use of ambulances did not increase. Only one study reported that survival was unaffected. There was a temporary increase in the numbers of patients admitted to the emergency department with non-cardiac chest pain in the initial phase of educational campaigns. CONCLUSION: The challenge of shortening the delay between the onset of infarction and the start of treatment remains. The campaigns so far have not been proved to be worthwhile and it is not certain that further campaigns will do better. New media campaigns should be run to establish whether a different type of message is more likely to change the behaviour of people in this life-threatening situation.

Prehospital delay in patients with acute coronary heart disease: concordance between patient interviews and medical records

Patient-associated delay in seeking medical care in the setting of acute coronary disease is assuming increasing importance as the benefits of reperfusion therapies become more time dependent. Given the importance of accurate information concerning prehospital delay, we examined the extent of concordance between information reported by patients in structured interviews by hospital staff nurses compared with information about time of acute symptom onset as recorded in the medical record. Data were obtained from 1137 patients with a discharge diagnosis of coronary heart disease who were admitted to six coronary care units in the Minneapolis-St. Paul metropolitan area. The average and median durations of prehospital delay were similar as reported in the structured personal interviews and through the review of medical records for the respective disease groups. The extent of individual level of agreement of delay time was considerably poorer, however. The Pearson correlation coefficients on the logarithmically transformed data were 0.48, 0.50, and 0.59 for persons with acute myocardial infarction, unstable angina, and chronic coronary disease, respectively, in comparing data noted in the medical record with that obtained in the personal interviews concerning prehospital delay time. These results suggest good agreement between personal interviews and medical record accounts in characterizing the average length of prehospital delay at the aggregate level but considerably less agreement at the individual patient level.