The Rapid Early Action for Coronary Treatment Study
(REACT)
Objectives:
This multicenter controlled community study developed
and evaluated the impact of a community educational intervention program on
patient delay time from onset of symptoms of an AMI to arrival at a hospital
emergency department.
Background:
Although early reperfusion or thrombolytic therapy can
reduce morbidity and mortality following an acute myocardial infarction (AMI),
delayed access to medical care in patients is relatively common. Mean delay
times from symptom onset to hospital arrival range from more than 4 hours to 24
hours, and the largest component of prolonged delay is patient recognition and
action.
Subjects:
A total of 20 Communities from 5 field centers in the
U.S. were pair-matched (10 pairs) according to geographic proximity and
demographic characteristics. After initiation of a 4 month baseline
surveillance period one community in each pair was randomly selected to receive
the intervention. The baseline surveillance period was followed by an 18 month
community intervention and surveillance period. The community surveillance
captured a total of 59,944 adults aged 30 years or older presenting to hospital
emergency departments with chest pain, of whom 20,364 met study criteria for
suspected acute coronary heart disease (CHD) at admission and discharged with a
CHD diagnosis.
Conclusions:
Delay times were decreased in the intervention and
reference communities. The results showed that the multicomponent community
intervention program did not differentially reduce delay time from onset of
acute MI symptoms to arrival at a hospital, but did significantly increase the
use of Emergency Medical Services by these patients in the intervention
communities. (JAMA 2000;284:60-67).
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