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A systematic review of educational interventions aiming to reduce prehospital delay in patients with acute coronary syndrome
  1. Sophia Hoschar1,2,
  2. Loai Albarqouni1,3 and
  3. Karl-Heinz Ladwig4,5
  1. 1Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum, München, German Research Center for Environmental Health, Neuherberg, Germany
  2. 2Department of Psychosomatic Medicine and Psychotherapy, Medical Center- University of Freiburg, Faculty of Medicine, Freiburg, Germany
  3. 3Institute for Evidence Based Healthcare, Bond University, Gold Coast, Queensland, Australia
  4. 4Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partnersite Munich, Munich, Germany
  5. 5Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
  1. Correspondence to Professor Karl-Heinz Ladwig; ladwig{at}


Interventions aiming at reducing prehospital delay (PHD) in patients with acute coronary syndrome (ACS) have yielded inconsistent findings. Therefore, we aimed to systematically review studies which investigated the impact of educational interventions on reducing PHD in patients with ACS. We searched four electronic databases (Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Embase, Cochrane) from inception throughout December 2016 for studies that reported the impact of either mass-media or personalised intervention on PHD. Reporting quality was assessed with the Template for Intervention Description and Replication checklist for interventional trials. Two reviewers screened 12 184 abstracts and performed full-text screening on 86 articles, leading to 34 articles which met our inclusion criteria. We found 18 educational interventions with a total of 180 914 participants (range: n=100–125 161) and a median of 1342 participants. Among these educational interventions, 13 campaigns employed a mass-media approach and five a personalised approach. Ten studies yielded no significant effects on the primary outcome while the remaining interventions reported a significant reduction with a decrease between 17 and 324 min (median reduction: 40 min, n=5). The success was partly driven by an increase in emergency medical services use. Two studies reported an increase in acute myocardial infarction knowledge. We observed no superiority of the personalised over the mass-media approach. Although methodological shortcomings and the heterogeneity of included interventions still do not allow definite recommendations for future campaigns, it becomes evident that either mass media or personalised interventions can be successful in reducing PHD, especially those who address behavioural consequences and psychological barriers (eg, denial) and provide practical action plan considerations as part of their campaign messages. CRD42017055684 (PROSPERO registration number).

  • acute coronary syndrome
  • education
  • public health

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  • Contributors SH made manual investigations to identify existing literature on the topic. SH and LA designed the review and outlined a search protocol, which was registered on PROSPERO. LA conducted the search for literature. LA and SH screened all titles and abstracts using RAYYAN. Full-text versions were screened for eligibility by SH and LA and data were extracted in an excel sheet. K-HL was included in all decisions regarding eligibility. LA, SH and K-HL drafted the manuscript. SH finalised the manuscript. SH, LA and K-HL take responsibility for all aspects of reliability and freedom from bias of the data presented and their discussed interpretation.

  • Funding This research was partly funded (8810002296) by the German Heart Foundation (Deutsche Herzstiftung) to Professor K-HL.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Available upon request from the corresponding author.

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