RAPID EARLY ACTION FOR CORONARY TREATMENT - RATIONALE, DESIGN, AND BASE-LINE CHARACTERISTICS

Objective: Early reperfusion for acute myocardial infarction (AMI) can reduce morbidity and mortality, yet there is often delay in accessing medical care after symptom onset. This report describes the design an d baseline characteristics of the Rapid Early Action for Coronary Trea tment (REACT) community trial, which is testing community intervention to reduce delay. Methods: Twenty U.S. communities were pair-matched a nd randomly assigned within pairs to intervention or comparison. Four months of baseline data collection was followed by an 18-month interve ntion of community organization and public, patient, and health profes sional education. Primary cases were community residents seen in the E D with chest pain, admitted with suspected acute cardiac ischemia, and discharged with a diagnosis related to coronary heart disease. The pr imary outcome was delay time from symptom onset to ED arrival. Seconda ry outcomes included delay time in patients with MI/unstable angina, h ospital case-fatality rate and length of stay, receipt of reperfusion, and ED/emergency medical services utilization. Impact on public and p atient knowledge, attitudes, and intentions was measured by telephone interviews. Characteristics of communities and cases and comparability of paired communities at baseline were assessed. Results: Baseline ca ses are 46% female, 14% minorities, and 73% aged greater than or equal to 55 years, and paired communities have similar demographics charact eristics. Median delay time (available for 72% of cases) is 2.3 hours and does not vary between treatment conditions (p > 0.86). Conclusions : REACT communities approximate the demographic distribution of the Un ited States and there is baseline comparability between the interventi on and comparison groups. The REACT trial will provide valuable inform ation for community educational programs to reduce patient delay for A MI symptoms.