IMPACT OF A PUBLIC CAMPAIGN ON PREHOSPITAL DELAY IN PATIENTS REPORTING CHEST PAIN

Objective - To decrease pre-hospital delay in patients with chest pain . Design - Population based, prospective observational study. Setting - A province of Switzerland with 380 000 inhabitants. Subjects - All 1 337 patients who presented with chest pain to the emergency department of the Hopital Cantonal Universitaire of Geneva during the 12 months of a multimedia public campaign, and the 1140 patients who came with s imilar symptoms during the 12 months before the campaign started. Main outcome measures - Pre-hospital infarction (AMI) and unstable angina. Results - Mean pre-hospital delay decreased from 7h 50min before the campaign to 4h 54min during it, and median delay from 180min to 155min (P < 0.001). For patients with a final diagnosis of AMI, mean delay d ecreased from 9h 10min to 5h 10min and median delay from 195min to 155 min (P < 0.002). Emergency department visits per week for AMI and unst able angina increased from 11.2 before the campaign to 13.2 during it (P < 0.02), with an increase to 27 (P < 0.01) during the first week of the campaign; visits per week for non-cardiac chest pain increased fr om 7.6 to 8.1 (P = NS) during the campaign, with an increase to 17 (P < 0.05) during its first week. Conclusions - Public campaigns may sign ificantly reduce pre-hospital delay in patients with chest pain. Despi te transient increases in emergency department visits for non-cardiac chest pain, such campaigns may significantly increase hospital visits for AMI and unstable angina and thus be cost effective.