Rapid Early Action for Coronary Treatment (REACT)
Condition: Cardiovascular Diseases; Coronary Disease; Heart Diseases; Myocardial Infarction; Myocardial Ischemia
MeSH terms: Cardiovascular Diseases; Heart Diseases; Myocardial Infarction; Coronary Disease; Myocardial Ischemia; Infarction; Ischemia
Study type: Interventional
Phase: Phase 3

Summary: 
      To evaluate the impact of community educational interventions on patient delay time from
      onset of symptoms and signs of an acute myocardial infarction (AMI) to arrival at a hospital
      Emergency Department (ED). Also, to study the impact of community educational interventions
      on use of Emergency Medical Services (EMS) and EDs, on thrombolytic therapy, and on AMI case
      fatality.
    

Detailed description: 
      BACKGROUND:

      Since the advent of thrombolytic therapy, early treatment holds particular promise for
      decreasing mortality from coronary heart disease. Thrombolytic therapy can reduce mortality
      by 25 percent for patients treated within the first few hours of AMI symptoms, with greater
      benefit the earlier the treatment. Not everyone who could benefit from receiving thrombolytic
      therapy receives such therapy. One contributing factor is that many people with symptoms do
      not seek emergency care in a timely manner. Studies show substantial delay times from AMI
      symptoms to hospital arrival, with means ranging from 4.6 to 24 hours and medians from 2 to
      6.4 hours. EMS transport time is estimated to average 7 to 22 minutes, so a large portion of
      pre-hospital delay is attributable to patient recognition and action. Several factors have
      been associated with delay time. Sudden onset pain is associated with shorter delay times,
      and older age, female gender, African-American race, consultation with others about symptoms,
      and self-treatment programs are associated with longer delay times. There is a need for
      educational programs that are effective in decreasing delay times, particularly by focusing
      on people who are at increased risk of having an AMI and groups more likely to delay seeking
      treatment.

      Community interventions to reduce delay time between AMI symptoms and contact with the
      medical system have been conducted in Britain, Canada, Sweden, Australia, Germany, King
      County in Washington, and Jacksonville, Illinois. The interventions have been promising, but
      the studies suffer from problems that make the reported results difficult to interpret.
      Almost all the published studies assessed delay time pre-to-post intervention and had no
      control or comparison group, making the magnitude and significance of impact from the
      intervention difficult to determine. Most were conducted in countries other than the United
      States, so applicability to the health-care system in the United States is questionable.
      Although some examined the effect of a public education program on ambulance and ED
      utilization, the effects of public education campaigns on use of the EMS or ED remains
      unanswered.

      DESIGN NARRATIVE:

      The study was a multicenter, controlled community trial where the community was the unit of
      assignment and of analysis. Twenty study communities were pair-matched on demographics and
      one of each pair was randomly assigned to intervention and one to control. The intervention
      communities received an 18-month community-based intervention to reduce delay time for
      symptoms and signs of AMI, focusing on decreasing the delay time associated with patient
      recognition and action. Several methods were used including: educational interventions based
      on behavior change theory; patient and provider education; public education and community
      organization. The primary outcome was time from symptom onset to arrival at the emergency
      department. Data collection and intervention continued until competion of 18 months of
      intervention.
    

Intervention name(s): health education
Intervention type(s): Behavioral
Primary purpose: Treatment