But new study design might change response times, researcher says
WEDNESDAY, Oct. 7 (HealthDay News) -- A study to tell whether educating heart patients about the symptoms of heart attack would make them respond faster when one happens has produced negative results, but the researchers say a few changes in trial design might make a second look at the issue worthwhile.
The research included 3,522 people with known heart disease in six cities in the United States, Australia and New Zealand. Half were given lessons on the symptoms of a heart attack and what to do when they occurred -- essentially, get to a hospital quickly -- with a follow-up call a month later to be sure the lessons had been learned. The other half received standard medical care. Both groups were called every six months to check whether they had sought emergency heart care.
Among the 3,087 people who were followed for two years, 305 in the education group sought emergency care, compared to 260 in the no-education group. The average time from symptoms to hospital admission was virtually the same for the two groups -- 2.20 hours with education, 2.25 hours without education, the researchers found.
But there should have been a third group in the study, said Barbara J. Riegel, a professor of nursing at the University of Pennsylvania and a member of the consortium of nurses reporting the trial in the Oct. 6 online edition of Circulation.
That would be a group that received neither education nor follow-up phone calls, she said.
The follow-up phone calls made to people in the no-education group might have made them more aware of the need to seek emergency care, Riegel explained.
"The response times were actually pretty low," Riegel said of both groups. "The fact that we called frequently to collect data might have affected their responses."
And so another trial with a third group that is left alone entirely is needed, Riegel said, and some changes might be made in the education program. "We'd like to do a study with a more powerful intervention," she said. "The one booster call a month later might not be strong enough to alter the response time."
Plans for such a study already are being made, with hopes for government funding. And meanwhile, Riegel said, the trial was not a total loss. "We've learned a ton from this one," she said.
The heart attack symptom that everyone knows is discomfort and/or pain in the chest that lasts for a few minutes or recurs. Other symptoms can include discomfort in the upper part of the body, perhaps affecting the arms, the back or the jaw; shortness of breath, with or without chest pain; a cold sweat, nausea or lightheadedness. A 911 call for emergency medical service or a quick trip to a hospital emergency room is recommended when those symptoms occur, with artery-clearing treatment most effective when started within 90 minutes of onset.
There were glimmers of hope in the results. Response times in the education group were shorter in the first six months after the education session, and people in the education group were more likely to take aspirin, which helps prevent artery-blocking blood clots, when they felt chest pain or had other heart attack symptoms.
But the trial's disappointing results might have been influenced by another possible mistake, which was downplaying the dangers of a delayed response during the education phase of the trial, said study leader Kathleen Dracup, dean of the school of nursing at the University of California, San Francisco.
"We assured patients about the interventions that would reverse the [heart attack] process," Dracup said. "We emphasized the positives about seeking help early, and didn't focus on what happens when you don't seek help early. We wanted to reassure patients that the health-care system would take care of them, when in reality the dangers can always be great."
A realistic description of what might happen if response to a heart attack is delayed will be part of any future trial, Dracup added.
The symptoms of a heart attack, and what to do when it occurs, are described by the American Heart Association.
SOURCES: Barbara J. Riegel, R.N., DNSc, professor, nursing, University of Pennsylvania, Philadelphia; Kathleen Dracup, R.N., DNSc, dean, school of nursing, University of California, San Francisco; Oct. 6, 2009, Circulation, online
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