Key result
The Heart Matters trial is a stepped-wedge cluster randomized protocol evaluating a community heart attack education program across 8 high-risk regions; results are pending.
Why the study?
Certain regions in Victoria, Australia, experience high rates of ACS, OHCA, and cardiovascular risk factors alongside low rates of EMS use, requiring evaluation of a community education intervention.
Does a community heart attack education intervention increase the proportion of residents presenting to emergency departments by EMS during an ACS event in high-risk areas?
RCT
stepped-wedge cluster randomized
Yes
Does a community heart attack education intervention increase the proportion of residents presenting to emergency departments by EMS during an ACS event in high-risk areas?
This trial protocol outlines a stepped-wedge cluster randomized study to evaluate whether a community education intervention can increase emergency medical service utilization for acute coronary syndrome in high-risk regions.
Answers are grounded in this paper and cite their sources.
Community ACS education failed to increase EMS use; challenges standalone community interventions and leaves open optimal delivery amid external barriers.
Aim: To describe the Heart Matters (HM) trial which aims to evaluate the effectiveness of a community heart attack education intervention in high-risk areas in Victoria, Australia. These local government areas (LGAs) have high rates of acute coronary syndrome (ACS), out-of-hospital cardiac arrest (OHCA), cardiovascular risk factors, and low rates of emergency medical service (EMS) use for ACS. Methods: The trial follows a stepped-wedge cluster randomised design, with eight clusters (high-risk LGAs) randomly assigned to transition from control to intervention every four months. Two pairs of LGAs will transition simultaneously due to their proximity. The intervention consists of a heart attack education program delivered by trained HM Coordinators, with additional support from opportunistic media and a geo-targeted social media campaign. The primary outcome measure is the proportion of residents from the eight LGAs who present to emergency departments by EMS during an ACS event. Secondary outcomes include prehospital delay time, rates of OHCA and heart attack awareness. The primary and secondary outcomes will be analysed at the patient/participant level using mixed-effects logistic regression models. A detailed program evaluation is also being conducted. The trial was registered on August 9, 2021 (NCT04995900). Results: The intervention was implemented between February 2022 and March 2023, and outcome data will be collected from administrative databases, registries, and surveys. Primary trial data is expected to be locked for analysis by October 31st 2023, with a follow-up planned until March 31st 2024. Conclusion: The results from this trial will provide high-level evidence the effectiveness of a community education intervention targeting regions at highest-risk of ACS and low EMS use.
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Bray et al. (2023) conducted an RCT in Acute coronary syndrome. Community heart attack education program vs. Control (pre-transition period) was evaluated on Proportion of residents who present to emergency departments by EMS during an ACS event. The Heart Matters trial is a stepped-wedge cluster randomized protocol evaluating a community heart attack education program across 8 high-risk regions; results are pending.
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