Dracup Kathleen, McKinley Sharon, Riegel Barbara, Moser Debra K, Meischke Hendrika, Doering Lynn V, Davidson Patricia, Paul Steven M, Baker Heather, Pelter Michele
University of California, San Francisco, CA, USA.
Circ Cardiovasc Qual Outcomes. 2009 Nov;2(6):524-32. doi: 10.1161/CIRCOUTCOMES.109.852608. Epub 2009 Oct 6.
Delay from onset of acute coronary syndrome (ACS) symptoms to hospital admission continues to be prolonged. To date, community education campaigns on the topic have had disappointing results. Therefore, we conducted a clinical randomized trial to test whether an intervention tailored specifically for patients with ACS and delivered one-on-one would reduce prehospital delay time.
Participants (n=3522) with documented coronary heart disease were randomized to experimental (n=1777) or control (n=1745) groups. Experimental patients received education and counseling about ACS symptoms and actions required. Patients had a mean age of 67+/-11 years, and 68% were male. Over the 2 years of follow-up, 565 patients (16.0%) were admitted to an emergency department with ACS symptoms a total of 842 times. Neither median prehospital delay time (experimental, 2.20 versus control, 2.25 hours) nor emergency medical system use (experimental, 63.6% versus control, 66.9%) was different between groups, although experimental patients were more likely than control to call the emergency medical system if the symptoms occurred within the first 6 months following the intervention (P=0.036). Experimental patients were significantly more likely to take aspirin after symptom onset than control patients (experimental, 22.3% versus control, 10.1%, P=0.02). The intervention did not result in an increase in emergency department use (experimental, 14.6% versus control, 17.5%).
The education and counseling intervention did not lead to reduced prehospital delay or increased ambulance use. Reducing the time from onset of ACS symptoms to arrival at the hospital continues to be a significant public health challenge.
clinicaltrials.gov. Identifier NCT00734760.
从急性冠状动脉综合征（ACS）症状发作到入院的延迟时间仍在延长。迄今为止，关于该主题的社区教育活动效果不佳。因此，我们开展了一项临床随机试验，以测试专门为ACS患者量身定制并进行一对一实施的干预措施是否会减少院前延迟时间。
有冠心病记录的参与者（n = 3522）被随机分为试验组（n = 1777）和对照组（n = 1745）。试验组患者接受了关于ACS症状及所需采取行动的教育和咨询。患者的平均年龄为67±11岁，68%为男性。在2年的随访期内，565名患者（16.0%）因ACS症状共842次被送往急诊科。两组之间的院前延迟时间中位数（试验组为2.20小时，对照组为2.25小时）和紧急医疗系统使用率（试验组为63.6%，对照组为66.9%）均无差异，不过如果症状在干预后的前6个月内出现，试验组患者比对照组患者更有可能呼叫紧急医疗系统（P = 0.036）。症状发作后试验组患者服用阿司匹林的可能性显著高于对照组患者（试验组为22.3%，对照组为10.1%，P = 0.02）。该干预措施并未导致急诊科使用率增加（试验组为14.6%，对照组为17.5%）。
教育和咨询干预并未减少院前延迟或增加救护车使用。缩短从ACS症状发作到医院就诊的时间仍然是一项重大的公共卫生挑战。
clinicaltrials.gov。标识符NCT00734760。
