A randomized controlled trial to reduce prehospital delay time in patients with acute coronary syndrome (ACS)

Background: The literature suggests that people delay too long prior to attending emergency departments with acute coronary syndrome (ACS) symptoms. This delay is referred to as prehospital delay. Patient decision delay contributes most significantly to prehospital delay. Objectives: Using a randomized controlled trial, we tested an educational intervention to reduce patient prehospital delay in ACS and promote appropriate responses to symptoms. Methods: Eligible patients who were admitted across five emergency departments (EDs) in Dublin were recruited to the study (n = 1944; control: 972, intervention: 972). Results: Median baseline prehospital delay times did not differ significantly between the groups at baseline (Mann-Whitney U, p = 0.34) (Control: 4.28 h, 25th percentile = 1.71, 75th percentile = 17.37; Intervention 3.96 h, 25th percentile = 1.53, 75th percentile = 18.51). Both groups received usual in-hospital care. In addition, patients randomized to the intervention group received a 40-min individualized education session using motivational techniques. This was reinforced 1 month later by telephone. Of the 1944, 314 (16.2%) were readmitted with ACS symptoms: 177 (18.2%) and 137 (14.1%) of the intervention and control groups, respectively. Prehospital delay times were again measured. Median delay time was significantly lower in the intervention compared to the control group (1.7 h vs. 7.1 h;