A community-based heart attack education program was associated with lower emergency medical service use among patients with acute coronary syndrome, according to a recent study.
In the stepped-wedge cluster randomized clinical trial, researchers evaluated a multicomponent heart attack education campaign designed to improve the recognition of acute coronary syndrome (ACS) symptoms and increase the use of emergency medical services (EMS) across eight high-risk communities in Victoria, Australia. The intervention included in-person sessions, mailed materials, resource handouts, and media outreach, and a geotargeted social-media campaign. Outcomes were assessed using administrative data sets and clinical registries involving 1,775 patients with ACS presenting to emergency departments. The primary outcome was the proportion of patients transported to the hospital by EMS.
During the intervention period, EMS use was 63.4% in the intervention period vs 68.6% in the control period, a difference of just over 5 percentage points.
Secondary outcomes showed reduced timely care-seeking during the intervention. Among patients with ST-elevation myocardial infarction, a smaller proportion sought care within 60 minutes of symptom onset, and fewer patients undergoing revascularization overall presented to the hospital within 2 hours. Other measures, including emergency department visits for unspecified chest pain and non-chest pain EMS call volumes, showed minimal differences between the control and itnervention periods.
In subgroup analyses, reductions in EMS use were more pronounced in metropolitan areas and during periods affected by flooding, although the estimates were variable.
The researchers noted that EMS use was unusually high early in the control period, coinciding with the COVID-19 pandemic , which may have elevated baseline rates. Additional external factors—including seasonal variation; flooding; and community concerns about EMS costs, demand, and wait times—may have influenced patient behavior. The intervention’s duration and reach were also limited, and patient-level exposure to the campaign couldn't be directly measured.
In this population, the education campaign was not found to improve EMS use or early care-seeking for ACS, and the researchers suggested that contextual factors may affect the impact of community-based interventions.
“These findings suggest that community education interventions are complex and can be influenced by external factors that may negate the intervention’s impact,” wrote lead study author Janet E. Bray, PhD, of the School of Public Health and Preventive Medicine at Monash University, and colleagues.
The study was funded by a National Health and Medical Research Council partnership grant with contributions from the Heart Foundation of Australia, the Victorian Department of Health, and Ambulance Victoria. Full disclosures of the study authors can be found in the study.
Source: JAMA Network Open