MASS-MEDIA AND TARGETED EDUCATION INTERVENTIONS TO MINIMIZE DELAY TO HOSPITAL IN PATIENTS WITH CHEST PAIN: A SYSTEMATIC REVIEW

Abstract

<h3>BACKGROUND</h3> Despite many improvements in percutaneous coronary intervention (PCI) and hospital systems of care, delay in seeking medical attention remains a significant barrier to timely reperfusion in acute coronary syndromes (ACS). Though previous studies have examined the risk factors associated with prolonged delays in accessing care, the data on education interventions to mitigate these factors is mixed. The aim of this systematic review is to examine the overall efficacy and methods of intervention available to minimize these delays. <h3>METHODS AND RESULTS</h3> We searched EMBASE, PubMED and MEDLINE from their inception to January 2021. Studies examining the association between either education intervention or mass media campaigns and delays in care (both patient delay and/or healthcare system delay) in ACS were included. Two independent reviewers performed level 1 screening of 6256 abstracts, which resulted in 95 studies for level 2 screening. After full manuscript review, these studies were then tailored to 26 studies with 17 companion articles for final data extraction. See Figure 1. In total, 20 studies used mass media campaigns, 5 targeted high-risk populations and 1 used a combination of both strategies (see Table 1). The key messages of these interventions were to appropriately identify ACS symptoms, and to call emergency medical services (EMS) for timely access to care. The majority of studies examined the effect on patient delays in care (n=15), of which 80% were effective. The use of EMS in the setting of potential ACS (n=14) was increased in 64% of studies after the intervention. There were also two studies that demonstrated decreased infarct size and mortality post-intervention. Several studies examined patient knowledge outcomes alone (n=4). In all studies examined, educational elements and mass media interventions relied heavily on print materials, radio and television. There was little to no presence of internet-based resources or social media. <h3>CONCLUSION</h3> Despite significant heterogeneity, there is evidence to support the efficacy of education interventions to reduce delay in patients with chest pain. The use of similar methods using an internet-based platform is an interesting possibility that has not yet been explored in the current body of literature.