66 Improving recognition and response to acute coronary syndrome: a narrative review of international public health awareness campaigns and implications for Ireland

Background Early recognition of acute coronary syndrome (ACS) symptoms and rapid activation of emergency medical services (EMS) are essential determinants of outcome in ST-elevation myocardial infarction (STEMI). Delayed presentation is associated with increased infarct size and mortality. The Irish Heart Attack Audit 2024 reported that only 45% of STEMI patients sought medical help within one hour of symptom onset, while approximately one-quarter self presented to non-PCI centres. The audit recommended a national public awareness campaign to improve symptom recognition and encourage timely EMS activation. Methods A narrative review of international public health campaigns targeting ACS symptom awareness and EMS utilisation was performed. Studies from Europe, North America and Australia were reviewed, including both mass-media and personalised educational interventions. Results A 2020 systematic review encompassing 18 interventions and over 180,000 participants found that 6 of 13 mass-media campaigns achieved statistically significant reductions in pre-hospital delay, with reductions of up to 40 minutes reported. Eight campaigns demonstrated increased EMS utilisation ranging from 2–24%. An Irish personalised educational intervention reported a 5.4-hour reduction in pre-hospital delay among high-risk patients without significantly increasing EMS burden. Australian ‘Warning Signs’ campaigns were associated with an 8.8% increase in EMS attendances for chest pain and a 5.6% reduction in EMS-treated out-of-hospital cardiac arrest during campaign months. Additional Australian data demonstrated a 23% reduction in GP referrals for ACS presentations and a 15.4% increase in ambulance utilisation during active campaigns. European campaigns similarly increased EMS activation and direct transport to PCI centres; however, reductions in symptom-to-first-medical-contact times were inconsistent. Several studies highlighted that successful campaigns addressed psychological barriers including denial and hesitation, while emphasising atypical ACS presentations and the importance of early EMS contact. Conclusion International evidence suggests public awareness campaigns can improve EMS utilisation and reduce delays in ACS presentation. Similar strategies could help address persistent pre-hospital delays in Ireland.