Abstract 1822: Impact on Anxiety of an Education and Counseling Intervention Designed to Decrease Treatment Seeking Delay in Response to Acute Coronary Syndrome (ACS) Symptoms

Abstract

Background: Patient delay in seeking treatment for ACS symptoms remains a substantial problem with most people delaying more than 2 hours before they seek treatment. Thus, it is vital to test interventions to improve this behavior, but at the same time it is essential that such interventions not increase anxiety. Given that these interventions seek to decrease patient denial of the seriousness of symptoms, it is possible that they may increase anxiety. Purpose: To determine the impact on anxiety of an individual face-to-face education and counseling intervention designed to decrease patient delay in seeking treatment for ACS symptoms. Methods: This was a multicenter randomized (intervention vs. usual care) controlled trial of the intervention in which anxiety data were collected (using the Multiple Affect Adjective Checklist) at baseline, 3-months and 12-months after the intervention. A total of 3522 patients with confirmed coronary artery disease (CAD) who were at risk for ACS were enrolled; data from 2597 patients with complete anxiety data at all three time points are included here. There were no differences in patients completing all three time points and those who did not. The intervention consisted of a 45 minute education and counseling session, reinforced by a phone call one month later in which the social, cognitive and emotional responses to ACS symptoms were discussed as were barriers to early treatment seeking. Repeated measures ANCOVA was used to compare anxiety levels across time between the groups controlling for age and gender. Results: There were significant differences in anxiety by group (p = 0.014). Anxiety level was stable in patients in the control group, but decreased by 10% at 3 months in the intervention group and remained at this reduced level at 12 months. Conclusion: An intervention designed to reduce patient delay in seeking treatment for ACS symptoms did not increase anxiety, but rather was associated with a reduction in anxiety. Interventions in which CAD patients directly confront the possibility of an acute cardiac event do not cause anxiety if they provide patients with appropriate strategies for managing symptoms.