Dracup Kathleen, McKinley Sharon, Riegel Barbara, Mieschke Hendrika, Doering Lynn V, Moser Debra K
School of Nursing, University of California, San Francisco, CA 94143, USA.
J Cardiovasc Nurs. 2006 May-Jun;21(3):186-93. doi: 10.1097/00005082-200605000-00006.
Prehospital delay in patients experiencing symptoms of acute coronary syndrome (ACS) has proved to be a significant and intractable public health problem, with minimal change in delay time over the past 2 decades despite numerous community education programs designed to reduce delay. With each 30-minute increment of delay, 1-year mortality increases by 7.5%, thus reinforcing the importance of helping patients label symptoms correctly and take appropriate action steps to seek definitive treatment. We therefore are conducting a multicenter, international clinical trial in 3,500 patients with documented coronary heart disease to determine whether a brief education and counseling intervention delivered by a nurse can reduce prehospital delay in the face of symptoms of ACS. The main outcome being studied is time from ACS symptom onset to arrival at the emergency department. Secondary outcomes include use of the emergency medical system; aspirin use; and knowledge, attitudes, and beliefs about heart attack symptoms. Patients are being followed for 2 years from the time of enrollment. The purpose of this article is to describe the intervention and its theoretical framework, and to outline the design of this randomized controlled trial.
事实证明，急性冠状动脉综合征（ACS）患者的院前延误是一个重大且棘手的公共卫生问题。尽管过去20年开展了许多旨在减少延误的社区教育项目，但延误时间几乎没有变化。每延误30分钟，1年死亡率就会增加7.5%，这进一步凸显了帮助患者正确识别症状并采取适当行动步骤寻求确定性治疗的重要性。因此，我们正在对3500名有冠心病记录的患者进行一项多中心国际临床试验，以确定护士提供的简短教育和咨询干预能否减少ACS症状出现时的院前延误。正在研究的主要结果是从ACS症状发作到抵达急诊科的时间。次要结果包括急救医疗系统的使用、阿司匹林的使用，以及对心脏病发作症状的知识、态度和信念。从入组开始，对患者进行为期2年的随访。本文的目的是描述干预措施及其理论框架，并概述这项随机对照试验的设计。
