School of Nursing, University of Pennsylvania, Philadelphia, PA 19104-4217, USA.
Patient Educ Couns. 2011 Nov;85(2):e33-8. doi: 10.1016/j.pec.2011.01.016. Epub 2011 Feb 5.
Prolonged prehospital delay in persons experiencing acute coronary syndrome (ACS) remains a problem. Understanding which patients respond best to particular interventions designed to decrease delay time would provide mechanistic insights into the process by which interventions work.
In the PROMOTION trial, 3522 at-risk patients were enrolled from 5 sites in the United States (56.4%), Australia and New Zealand; 490 (N=272 intervention, N=218 control) had an acute event within 2 years. Focusing on these 490, we (1) identified predictors of a rapid response to symptoms, (2) identified intervention group subjects with a change in these predictors over 3 months of follow-up, and (3) compared intervention group participants with and without the favorable response pattern. Hypothesized predictors of rapid response were increased perceived control and decreased anxiety. Knowledge, attitudes, and beliefs were hypothesized to differ between responders and non-responders.
Contrary to hypothesis, responders had low anxiety and low perceived control. Only 73 (26.8%) subjects showed this pattern 3 months following the intervention. No differences in ACS knowledge, attitudes, or beliefs were found.
The results of this study challenge existing beliefs.
New intervention approaches that focus on a realistic decrease in anxiety and perceived control are needed.
急性冠状动脉综合征（ACS）患者的院前延迟时间延长仍然是一个问题。了解哪些患者对旨在减少延迟时间的特定干预措施反应最好，可以深入了解干预措施发挥作用的机制。
在 PROMOTION 试验中，从美国（56.4%）、澳大利亚和新西兰的 5 个地点招募了 3522 名高危患者；其中 490 名（N=272 例干预组，N=218 例对照组）在 2 年内发生急性事件。针对这 490 名患者，我们（1）确定了对症状快速反应的预测因素，（2）确定了干预组中这些预测因素在 3 个月随访期间发生变化的患者，（3）比较了干预组中具有和不具有有利反应模式的患者。快速反应的假设预测因素是增加的感知控制和减少的焦虑。假设知识、态度和信念在反应者和非反应者之间存在差异。
与假设相反，反应者的焦虑和感知控制水平较低。仅 73 名（26.8%）患者在干预后 3 个月出现这种模式。在 ACS 知识、态度或信念方面没有发现差异。
这项研究的结果挑战了现有的观念。
需要新的干预方法，重点是降低焦虑和感知控制的现实程度。
