Shortening pre-hospital time delay in patients with acute myocardial infarction using a modelling-based narrative intervention with a virtual heart attack experience: a randomized controlled trial
Authors: Li P , Yu D S F , Yan B P Y , Wong C W , Yue S C S , Chan C M C , Chan S C 
Published: October 2021

Abstract

Background
Prolonged delay in seeking treatment by patients with acute myocardial infarction (AMI) remains a significant therapeutic gap. Previous mass-media campaigns or brief educational interventions were largely ineffective in shortening pre-hospital patient delay. The brevity and didactic nature of these interventions are inadequate to address complex decision-making encountered by patients with AMI.

Purpose
This randomized controlled trial examined the effects of a theory-driven modelling-based narrative intervention on AMI knowledge, care-seeking intention as indicated by attitudes and beliefs regarding care-seeking for AMI, prehospital delay time and use of ambulance among AMI survivors.

Methods
A total of 285 of patients with history of at least one AMI were randomized 1:1 to modelling-based narrative intervention (n=144) and control with didactic education (n=141). The modelling-based narrative intervention comprised 4 weekly group-based interactive sessions to engage participants in mental rehearsals of the perceptual-cognitive processes in recognizing and responding to AMI symptoms through a virtual heart attack experience, then followed by a booster session one month later The control group received a 4-weekly education on factual information about AMI with traditional didactic education approach. Study endpoints included AMI knowledge, attitudes and belief about care-seeking for AMI to be measured at baseline, (T0), 3 months (T1), 12 months (T2) and 24 months (T3) after the intervention. Prehospital delay time and use of ambulance for an AMI attack were tracked since patients' enrolment until T3 endpoint of the study.

Results
Generalized estimating equation analysis indicated that the participants in the intervention group had significantly greater improvement in attitudes and beliefs about care seeking for AMI symptoms at all endpoints than those in the control group (Table 1). There were no between-group differences in the change of AMI knowledge score over the baseline and 3- or 12-month endpoints, such difference became significant at 24-month endpoint. A total of 78 participants, including 38 (26.4%) in the intervention group and 40 (28.4%) in the control groups, had experienced AMI symptoms and admitted to an emergency department during the follow-up period. The participants in the intervention group showed significant reduction in prehospital delay time than the control group (p=0.031). There was no between-group difference on use of ambulance (p=0.422) for those participants who had symptom attack during the follow-up period.

Conclusion
This study demonstrated favorable effects in shortening prehospital time delay and promoting positive attitudes and beliefs regarding care-seeking for AMI symptoms among AMI survivors. A virtual heart attack experience helped support them through a cognitive-perceptual processes in recognizing and interpreting AMI symptoms.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Early Career Scheme, Research Grants Council, Hong Kong