Acute Coronary Syndrome, Myocardial Infarction, Acute
Conditions
Brief summary
The aim of the study is to evaluate whether providing a targeted heart health education campaign to regions at high risk of heart attacks will improve ACS patient's symptom recognition and response. The intervention will be will be evaluated according to a cluster randomized, stepped wedged design. The clusters are eight local government areas (LGAs) in Victoria, Australia. The main primary outcome will be assessed in consecutive patients presenting to emergency departments from the six LGAs throughout the study period with an ED diagnoses of acute coronary syndrome.
Detailed description
Primary objectives: To determine if targeted heart health education will: 1. Increase ambulance use in ACS patients (main primary outcome); 2. Decrease patient and prehospital delay times in ACS patients; 3. Increase awareness of personal cardiovascular risk and associated factors in adult community members; and 4. Increase cardiovascular knowledge and confidence to act to heart attack warning signs in adult community members. Secondary objectives 1. To determine if targeted heart health education: 2. Reduces the incidence of out-of-hospital cardiac arrest; 3. Improves survival in OHCA patients; 4. Improves survival in ACS patients; 5. Improves survival and ACS patients; 6. Increases presentations to ED for ACS and unspecified chest pain; and 7. Increases the rates of calls to ambulance for chest pain and non-chest pain. 8. Increases the rate of Heart Health Checks. Intervention: To meet the objectives of the study, we will employ HM coordinators for each of the eight high-risk LGAs to organise and deliver our HM education program using HM materials and Partner resources. Design: The stepped-wedge design is a uni-directional cross-over design - where the randomisation element is when the cluster crosses-over to the intervention following a control period. Over the 16-month study period, the eight LGAs will move into the intervention phase at two month intervals. As four LGAs are in close proximity, these LGAs will switch from control to intervention periods at the same time to avoid possible contamination.
Interventions
OTHERCommunity education
Heart Matters coordinators will deliver heart health education to the community using HM materials and Partner resources.
Sponsors
National Heart Foundation, Australia
Department of Health, Victorian Government
Ambulance Victoria
Monash University
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Masking description
Outcomes are collected blinded to the study allocation.
Intervention model description
The stepped-wedge design is a uni-directional cross-over design - where the randomisation element is when the cluster crosses-over to the intervention following a control period.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Adult residents of the eight local government areas -
Exclusion criteria
Adults not residing in the eight local government areas. \-
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Ambulance use for ACS | 16 months | The proportion of ACS patients that present to ED by ambulance. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| ACS patient delay time <60 minutes | 16 months | The proportion of ACS patients with patient delay times \<60 minutes |
| Median ACS patient prehospital delay time | 16 months | The median ACS patient prehospital delay time (time from symptom onset to arrival at hospital). |
| ACS patients prehospital delay times <120 minutes | 16 months | The proportion of ACS patients with prehospital delay times \<120 minutes |
| Awareness of own risk of heart attack | 0-2 months and 6-8 months | The proportion of adult members of the community who are aware of their own risk of heart attack. |
| Awareness of heart attack as a leading cause of death | 0-2 months and 6-8 months | The proportion of adult members of the community who identify heart disease a leading cause of death |
| Awareness of heart attack risk factors | 0-2 months and 6-8 months | The proportion of adult members of the community who identify cardiovascular risk factors |
| Number of correctly named heart attack risk factors | 0-2 months and 6-8 months | The number of correctly named cardiovascular risk factors by adult members of the community |
| Awareness of heart attack signs and symptoms | 0-2 months and 6-8 months | The proportion of adult members of the community aware of heart attack symptoms |
| Number of correctly named heart attack signs and symptoms | 0-2 months and 6-8 months | The number of correctly named ACS symptoms by adult members of the community |
| Confidence in knowing how to act | 0-2 months and 6-8 months | The proportion adult members of the community who are confident about what they would do if experiencing a heart attack |
| Median ACS patient delay time | 16 months | The median ACS patients delay time (time from symptom onset to decision to seek medical attention). |
| Rates of Heart Health Checks | 16 months | Rates of Medicare claims for General Practitioner (GP) Heart Health Checks |
| Rates of ACS ED presentations | 16 months | The rates of ED presentations that are ACS |
| Rates of unspecified chest pain ED presentations | 16 months | Rates of ED presentations that are unspecified chest pain |
| ACS ED presentations via GPs | 16 months | Proportion of ACS ED presentations via General Practitioners |
| Rates of ACS survival | 16 months | The proportion of ACS patients surviving to hospital discharge |
| Incidence of OHCA | 16 months | incidence of out-of-hospital cardiac arrest |
| Rates of OHCA | 16 months | Rates out-of-hospital cardiac arrest survival |
| Calls to ambulance for chest pain | 16 months | Proportion of chest pain (event type 10) calls to ambulance |
| Calls to ambulance for non- chest pain | 16 months | Proportion of non-chest pain emergency calls to ambulance |
| Ambulance use in scenarios | 0-2 months and 6-8 months | The proportion adult members of the community who correctly state they would call an ambulance for two heart attack scenarios. |
Countries
Australia
Outcome results
None listed