A randomized controlled trial to reduce prehospital delay time in patients with acute coronary syndrome (ACS)

J Emerg Med. 2014 Apr;46(4):495-506. doi: 10.1016/j.jemermed.2013.08.114. Epub 2014 Jan 8.


Background: The literature suggests that people delay too long prior to attending emergency departments with acute coronary syndrome (ACS) symptoms. This delay is referred to as prehospital delay. Patient decision delay contributes most significantly to prehospital delay.

Objectives: Using a randomized controlled trial, we tested an educational intervention to reduce patient prehospital delay in ACS and promote appropriate responses to symptoms.

Methods: Eligible patients who were admitted across five emergency departments (EDs) in Dublin were recruited to the study (n = 1944; control: 972, intervention: 972).

Results: Median baseline prehospital delay times did not differ significantly between the groups at baseline (Mann-Whitney U, p = 0.34) (CONTROL: 4.28 h, 25(th) percentile = 1.71, 75(th) percentile = 17.37; Intervention 3.96 h, 25(th) percentile = 1.53, 75(th) percentile = 18.51). Both groups received usual in-hospital care. In addition, patients randomized to the intervention group received a 40-min individualized education session using motivational techniques. This was reinforced 1 month later by telephone. Of the 1944, 314 (16.2%) were readmitted with ACS symptoms: 177 (18.2%) and 137 (14.1%) of the intervention and control groups, respectively. Prehospital delay times were again measured. Median delay time was significantly lower in the intervention compared to the control group (1.7 h vs. 7.1 h; p ≤ 0.001). Appropriately, those in the intervention group reported their symptoms more promptly to another person (p = 0.01) and fewer consulted a general practitioner (p = 0.02). There was no significant difference in ambulance use (p = 0.51) or nitrate use (p = 0.06) between the groups.

Conclusion: It is possible to reduce prehospital delay time in ACS, but the need for renewed emphasis on ambulance use is important.

Keywords: acute coronary syndrome; behavioral change; educational intervention; prehospital delay time; randomized controlled trial.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / therapy*
  • Aged
  • Ambulances / statistics & numerical data
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • General Practice / statistics & numerical data
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Ireland
  • Male
  • Middle Aged
  • Nitrates / therapeutic use
  • Patient Acceptance of Health Care*
  • Patient Education as Topic*
  • Patient Readmission
  • Recurrence
  • Time-to-Treatment*


  • Nitrates