Public Release: 

Scenario-based counseling may help patients seek hospital care sooner after a heart attack

University of California - San Francisco

Heart disease patients who receive one-to-one counseling about the range of heart attack symptoms and the emotions they are likely to feel during a heart attack may seek hospital care sooner after they have symptoms, according to a UCSF researcher. Previous research has shown that survival rates are improved by up to 50 percent when therapy is given within one hour of symptom onset, said Kathleen Dracup, RN, DNSc, Dean of the UCSF School of Nursing.

That rate declines to 23 percent when patients are treated within three hours of symptom onset and diminishes markedly when the intervention is received more than six hours after symptoms begin, she explained. "The sooner physicians reinstate blood supply, by a balloon angioplasty procedure that sometimes includes stent placement to hold the artery open or the use of medication to dissolve a clot, the better the outcome for the patient," said Dracup.

However, patients often delay their decision to seek treatment -- by hours and even days, if the symptoms are intermittent. Those who delay medical intervention most often experience symptoms while they are at home, appraise their symptoms as not serious, wait until the symptoms go away, and worry about troubling others, she said.

Dracup is the principal investigator on a $2.8 million, five-year National Institutes of Health (NIH) multicenter study to test the effectiveness of one-to-one counseling for patients with ischemic heart disease. Patients and their partners in the study are taught to recognize the diversity of symptoms of an evolving heart attack and appreciate the rewards of seeking help early. They also are asked to anticipate their symptoms and their possible emotional reactions to a heart attack and discuss the use of 911 (rather than driving to the hospital) and the benefits of taking an aspirin when symptoms begin (unless otherwise contraindicated) to reduce blood clots in the coronary arteries.

The intervention is an alternative to previous models, which have focused on educating the public using mass media. "Mass media campaigns help people gain new knowledge about treatment for heart attack, but they don't change behavior. People still don't use the information to get to the hospital more quickly," said Dracup. "These strategies aim to help patients address their emotional reaction to a heart attack threat, promote a controlled coping response (rather than an automatic emotional response like denial) and emphasize the possibilities of successfully coping with that health threat." She added that the inclusion of partners in the program is critical because most often they make the decision to seek help.

"The intervention is really a lot like a fire drill in your home. When you simulate an experience, it's easier to deal with when it actually happens," said Dracup. She explained that patients who go through a dry run are able to overcome the negative emotional responses that often accompany a health crisis.

In a previous study, Dracup and co-investigator Sharon McKinley, RN, PhD, professor at the University of Technology, Sydney, Australia analyzed the sociodemographic, clinical, cognitive, emotional and social factors in North American and Australian heart attack patients who arrived at the hospital within six hours of symptom onset.

Few patients on either continent made an appropriate initial response to their symptoms (calling an ambulance or going to the hospital). The most frequent response of heart attack sufferers in both countries was to try to relax, said Dracup. Half as many North Americans as Australians told a family member about their symptoms. "Clearly, individualized attempts to change behavior should address emotional responses, such as embarrassment and concern about troubling others," said Dracup.

Co-investigators on the study include, Lynn Doering DNSc, assistant professor, University of California Los Angeles; Sharon Mckinley, RN, PhD, professor University of Technology, Sydney; Hendrika Meischke, PhD, associate professor the University of Washington; Debra Moser, RN, DNSc, associate professor Ohio State University; and Barbara Reigel, RN, DNSc, professor, San Diego State University.

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The study is funded by the National Institutes of Health.

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