A review of interventions aimed at reducing pre-hospital delay time in acute coronary syndrome: what has worked and why?

Eur J Cardiovasc Nurs. 2012 Dec;11(4):445-53. doi: 10.1016/j.ejcnurse.2011.04.003. Epub 2012 Apr 4.


Background: Delay in seeking treatment for acute coronary syndrome (ACS) symptoms is a well recognised problem. While the factors that influence pre-hospital delay have been well researched, to date this information alone has been insufficient in altering delay behaviour.

Aim: This paper reports the results of a critical appraisal of previously tested interventions designed to reduce pre-hospital delay in seeking treatment for ACS symptoms.

Methods: The search was confined to interventions published between 1986 and the present that were written in English and aimed at reducing pre-hospital delay time. The following databases were searched using keywords: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Pubmed, Academic Search Premier, Ovid, Cochrane, British Nursing Index, and Google Scholar. A total of eight intervention studies were identified as relevant. This review was developed following a systematic comparative analysis of those eight studies.

Results: Seven of the eight interventions were based on mass media campaigns. One campaign was targeted at individuals. All were aimed at raising ACS symptom awareness and/or increasing prompt action in the presence of symptoms. Only two studies reported a statistically significant reduction in pre-hospital delay time.

Conclusion: In response to concerns about prolonged pre-hospital delay time in ACS, interventions targeting the problem have been developed. The literature indicates that responses to symptoms depend on a variety of factors. In light of this, interventions should include the scope of factors that can potentially influence pre-hospital delay time and ideally target those who are at greatest risk of an ACS event.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Acute Coronary Syndrome / diagnosis
  • Acute Coronary Syndrome / mortality
  • Acute Coronary Syndrome / therapy*
  • Aged
  • Aged, 80 and over
  • Emergency Medical Services / organization & administration*
  • Female
  • Humans
  • Ireland
  • Middle Aged
  • Needs Assessment
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Patient Admission / statistics & numerical data
  • Patient Education as Topic / organization & administration*
  • Randomized Controlled Trials as Topic
  • Risk Assessment
  • Survival Analysis
  • Time Factors