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Bray JE, Nehme Z, Finn JC, Kasza J, Clark RA, Stub D, Cadilhac DA, Buttery AK, Woods J, Kim J, Smith BJ, Smith K, Cartledge S, Beauchamp A, Dodge N, Walker T, Flemming-Judge E, Chow C, Stewart M, Cox N, van Gaal W, Nadurata V, Cameron P. A protocol for the Heart Matters stepped wedge cluster randomised trial: The effectiveness of heart attack education in regions at highest-risk. Resusc Plus 2023; 15:100431. [PMID: 37555197 PMCID: PMC10405322 DOI: 10.1016/j.resplu.2023.100431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
AIM To describe the Heart Matters (HM) trial which aims to evaluate the effectiveness of a community heart attack education intervention in high-risk areas in Victoria, Australia. These local government areas (LGAs) have high rates of acute coronary syndrome (ACS), out-of-hospital cardiac arrest (OHCA), cardiovascular risk factors, and low rates of emergency medical service (EMS) use for ACS. METHODS The trial follows a stepped-wedge cluster randomised design, with eight clusters (high-risk LGAs) randomly assigned to transition from control to intervention every four months. Two pairs of LGAs will transition simultaneously due to their proximity. The intervention consists of a heart attack education program delivered by trained HM Coordinators, with additional support from opportunistic media and a geo-targeted social media campaign. The primary outcome measure is the proportion of residents from the eight LGAs who present to emergency departments by EMS during an ACS event. Secondary outcomes include prehospital delay time, rates of OHCA and heart attack awareness. The primary and secondary outcomes will be analysed at the patient/participant level using mixed-effects logistic regression models. A detailed program evaluation is also being conducted. The trial was registered on August 9, 2021 (NCT04995900). RESULTS The intervention was implemented between February 2022 and March 2023, and outcome data will be collected from administrative databases, registries, and surveys. Primary trial data is expected to be locked for analysis by October 31st 2023, with a follow-up planned until March 31st 2024. CONCLUSION The results from this trial will provide high-level evidence the effectiveness of a community education intervention targeting regions at highest-risk of ACS and low EMS use.
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Affiliation(s)
- Janet E. Bray
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
- School of Nursing, Curtin University, Australia
- Alfred Health, Australia
| | - Ziad Nehme
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
- Ambulance Victoria, Australia
| | - Judith C. Finn
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
- School of Nursing, Curtin University, Australia
| | - Jessica Kasza
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
| | - Robyn A. Clark
- Caring Futures Institute, Flinders University, Australia
- Southern Adelaide Local Health Network, Australia
| | - Dion Stub
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
- Alfred Health, Australia
- Ambulance Victoria, Australia
| | - Dominique A. Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Australia
- Stroke Theme, Florey Institute of Neuroscience and Mental Health University of Melbourne, Australia
| | | | - Janelle Woods
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
- National Heart Foundation of Australia, Australia
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Australia
- Stroke Theme, Florey Institute of Neuroscience and Mental Health University of Melbourne, Australia
| | - Ben J. Smith
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
- Prevention Research Collaboration, School of Public Health, University of Sydney, Australia
| | - Karen Smith
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
- Department of Research and Innovation, Silverchain, Australia
| | - Susie Cartledge
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
| | | | - Natasha Dodge
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
| | - Tony Walker
- Department of Paramedicine, Monash University, Australia
| | | | - Clara Chow
- Faculty of Medicine and Health, Westmead Applied Research Centre, University of Sydney, Australia
- Westmead Hospital, Australia
| | | | | | | | | | - Peter Cameron
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
- Alfred Health, Australia
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Davis LL, McCoy TP, Riegel B, McKinley S, Doering LV, Moser DK. Association of Symptoms and Mode of Transportation to Emergency Department in Patients With Acute Coronary Syndrome. Dimens Crit Care Nurs 2023; 42:95-103. [PMID: 36720034 PMCID: PMC9897491 DOI: 10.1097/dcc.0000000000000566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Patients with acute coronary syndrome (ACS) with symptoms matching their expectations of a heart attack are more likely to use emergency medical services (EMS) than not. OBJECTIVE To determine whether presenting symptom clusters are associated with EMS use in ACS patients and if EMS use or symptom clusters are associated with prehospital delay. METHODS This secondary analysis used data from the PROMOTION trial, a randomized clinical trial that enrolled 3522 subjects with a history of or at risk for ACS from 5 sites in the United States, Australia, and New Zealand. Subjects were randomized to usual care or an educational intervention to reduce prehospital delay. During the 2-year follow-up, subjects admitted for ACS were asked about symptoms, time of symptom onset, and mode of transportation to the hospital. Symptoms were grouped into classic ACS, pain symptoms, and stress symptoms clusters. RESULTS Of 3522 subjects enrolled, 331 sought care for ACS during follow-up; 278 had transportation mode documented; 121 (44%) arrived via EMS. Classic ACS plus pain symptoms (adjusted odds ratio [AOR], 2.66; P = .011), classic ACS plus stress symptoms (AOR, 2.61; P = .007), and classic ACS plus both pain and stress symptoms (AOR, 3.90; P = .012) were associated with higher odds of EMS use versus classic ACS symptoms alone. Emergency medical services use resulted in a 68.5-minute shorter median delay (P = .002) versus non-EMS use. Symptom clusters were not predictive of delay time in the adjusted model (P = .952). DISCUSSION Although chest symptoms were the most prevalent symptoms for most (85%), the combination of classic ACS symptoms with other symptom clusters was associated with higher EMS use. Further research is needed to determine whether a combination of symptom clusters helps patients correctly interpret ACS symptoms to better understand how symptom clusters influence EMS use.
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Baldi E, Camporotondo R, Gnecchi M, Totaro R, Guida S, Costantino I, Repetto A, Savastano S, Sacchi MC, Bollato C, Giglietta F, Oltrona Visconti L, Leonardi S. Barriers associated with emergency medical service activation in patients with ST-segment elevation acute coronary syndromes. Intern Emerg Med 2022; 17:1165-1174. [PMID: 34826051 PMCID: PMC8616749 DOI: 10.1007/s11739-021-02894-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 11/13/2021] [Indexed: 11/12/2022]
Abstract
Many ST-segment elevation acute coronary syndrome (STEACS) patients fail to activate the Emergency Medical System (EMS), with possible dramatic consequences. Prior studies focusing on barriers to EMS activation included patients with any acute coronary syndrome (ACS) without representation of southern European populations. We aimed to investigate the barriers to EMS call for patients diagnosed for STEACS in Italy. A prospective, single-center, survey administered to all patients treated with primary percutaneous coronary intervention for STEACS in a tertiary hospital in northern Italy from 01/06/2018 to 31/05/2020. The questionnaire was filled out by 293 patients. Of these, 191 (65.2%) activated the EMS after symptoms onset. The main reasons for failing to contact EMS were the perception that the symptoms were unrelated to an important health problem (45.5%) and that a private vehicle is faster than EMS to reach the hospital (34.7%). Patients who called a private doctor after symptoms onset did not call EMS more frequently than those who did not and 30% of the patients who did not call the EMS would still act in the same way if a new episode occurred. Previous history of cardiovascular disease was the only predictor of EMS call. Information campaigns are urgently needed to increase EMS activation in case of suspected STEACS and should be primary focused on patients without cardiovascular history, on the misperception that a private vehicle is faster than EMS activation, and on the fact that cardiac arrest occurs early and may be prevented by EMS activation.
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Affiliation(s)
- Enrico Baldi
- Department of Molecular Medicine, Section of Cardiology, c/o Fondazione IRCCS Policlinico San Matteo, University of Pavia, Viale Golgi 19, 27100, Pavia, Italy.
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Rita Camporotondo
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Massimiliano Gnecchi
- Department of Molecular Medicine, Section of Cardiology, c/o Fondazione IRCCS Policlinico San Matteo, University of Pavia, Viale Golgi 19, 27100, Pavia, Italy
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Rossana Totaro
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefania Guida
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ilaria Costantino
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Repetto
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maria Clara Sacchi
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carola Bollato
- Anestesia E Rianimazione II Cardiopolmonare, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Giglietta
- Department of Molecular Medicine, Section of Cardiology, c/o Fondazione IRCCS Policlinico San Matteo, University of Pavia, Viale Golgi 19, 27100, Pavia, Italy
| | | | - Sergio Leonardi
- Department of Molecular Medicine, Section of Cardiology, c/o Fondazione IRCCS Policlinico San Matteo, University of Pavia, Viale Golgi 19, 27100, Pavia, Italy
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Wibring K, Lingman M, Herlitz J, Bång A. The potential of new prediction models for emergency medical dispatch prioritisation of patients with chest pain: a cohort study. Scand J Trauma Resusc Emerg Med 2022; 30:34. [PMID: 35527302 PMCID: PMC9080130 DOI: 10.1186/s13049-022-01021-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/25/2022] [Indexed: 08/30/2023] Open
Abstract
Abstract
Objectives
To develop emergency medical dispatch (EMD) centre prediction models with high sensitivity and satisfying specificity to identify high-priority patients and patients suitable for non-emergency care respectively, when assessing patients with chest pain.
Methods
Observational cohort study of 2917 unselected patients with chest pain who contacted an EMD centre in Sweden due to chest pain during 2018. Multivariate logistic regression was applied to develop models predicting low-risk or high-risk condition, that is, occurrence of time-sensitive diagnosis on hospital discharge.
Results
Prediction models were developed for the identification of patients suitable for high- and low-priority dispatch, using 11 and 10 variables respectively. The area under the receiver-operating characteristic curve (AUROC) for the high-risk prediction model was 0.79 and for the low-risk model it was 0.74. When applying the high-risk prediction model, 56% of the EMS missions were given highest priority, compared with 65% with the current standard. When applying the low-risk model, 7% were given the lowest priority compared to 1% for the current standard. The new prediction models outperformed today’s dispatch priority accuracy in terms of sensitivity as well as positive and negative predictive value in both high- and low-risk prediction. The low-risk model predicted almost six times as many patients as having low-risk conditions compared with today’s standard. This was done without increasing the number of high-risk patients wrongly assessed as low-risk.
Conclusions
By introducing prediction models, based on logistic regression analyses, using variables obtained by standard EMD-questions on age, sex, medical history and symptomology, EMD prioritisation can be improved compared with using current criteria index-based ones. This will allow a more efficient emergency medical services resource allocation.
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Eastwood K, Howell S, Nehme Z, Finn J, Smith K, Cameron P, Stub D, Bray JE. Impact of a mass media campaign on presentations and ambulance use for acute coronary syndrome. Open Heart 2021; 8:openhrt-2021-001792. [PMID: 34663748 PMCID: PMC8524379 DOI: 10.1136/openhrt-2021-001792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/23/2021] [Indexed: 11/07/2022] Open
Abstract
Objective Between 2009 and 2013, the National Heart Foundation of Australia ran mass media campaigns to improve Australian’s awareness of acute coronary syndrome (ACS) symptoms and the need to call emergency medical services (EMS). This study examined the impact of this campaign on emergency department (ED) presentations and EMS use in Victoria, Australia. Methods The Victorian Department of Health and Human Services provided data for adult Victorian patients presenting to public hospitals with an ED diagnosis of ACS or unspecified chest pain (U-CP). We modelled changes in the incidence of ED presentations, and the association between the campaign period and (1) EMS arrival and (2) referred to ED by a general practitioner (GP). Models were adjusted for increasing population size, ACS subtype and demographics. Results Between 2003 and 2015, there were 124 632 eligible ED presentations with ACS and 536 148 with U-CP. In patients with ACS, the campaign period was associated with an increase in ED presentations (incidence rate ratio: 1.11; 95% CI 1.07 to 1.15), a decrease in presentations via a GP (adjusted OR (AOR): 0.77; 95% CI 0.70 to 0.86) and an increase in EMS use (AOR: 1.10; 95% CI 1.05 to 1.17). Similar, but smaller associations were seen in U-CP. Conclusions The Warning Signs Campaign was associated with improvements in treatment seeking in patients with ACS—including increased EMS use. The increase in ACS ED presentations corresponds with a decrease in out-of-hospital cardiac arrest over this time. Future education needs to focus on improving EMS use in ACS patient groups where use remains low.
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Affiliation(s)
- Kathryn Eastwood
- Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Stuart Howell
- Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ziad Nehme
- Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia.,Department of Paramedicine, Monash University, Frankston, Victoria, Australia
| | - Judith Finn
- Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia
| | - Karen Smith
- Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia.,Department of Paramedicine, Monash University, Frankston, Victoria, Australia
| | - Peter Cameron
- Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Emergency and Cardiology Departments, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Dion Stub
- Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia.,Emergency and Cardiology Departments, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Janet E Bray
- Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia .,Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia.,Emergency and Cardiology Departments, The Alfred Hospital, Melbourne, Victoria, Australia
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