A protocol for the Heart Matters stepped wedge cluster randomised trial: The effectiveness of heart attack education
Janet E Bray1,2,3, Ziad Nehme1,4, Judith C Finn1,2
1Monash School of Public Health and Preventive Medicine, Monash University, Australia.
Insights
The Heart Matters trial tested a community education program to improve emergency medical service use for heart attacks in high-risk Australian areas. Results will show if this intervention effectively increases emergency response for acute coronary syndrome.
Area of Science:
- Public Health
- Cardiology
- Health Services Research
Background:
- High-risk areas in Victoria, Australia, face challenges with acute coronary syndrome (ACS) and out-of-hospital cardiac arrest (OHCA).
- These regions exhibit high cardiovascular risk factors and notably low utilization of emergency medical services (EMS) for ACS events.
- The Heart Matters (HM) trial addresses this gap by evaluating a targeted community education intervention.
Purpose of the Study:
- To evaluate the effectiveness of a community heart attack education intervention.
- To assess the impact on emergency medical service (EMS) utilization for acute coronary syndrome (ACS) in high-risk areas.
- To analyze changes in prehospital delay, OHCA rates, and public awareness of heart attack symptoms.
Main Methods:
- A stepped-wedge cluster randomized design involving eight high-risk local government areas (LGAs) in Victoria, Australia.
- Intervention delivery through trained HM Coordinators, supported by media campaigns and geo-targeted social media.
- Primary outcome: proportion of residents using EMS for ACS; analyzed using mixed-effects logistic regression.
Main Results:
- Intervention implementation occurred from February 2022 to March 2023.
- Outcome data collection from administrative databases, registries, and surveys.
- Primary trial data analysis expected by October 31st, 2023, with follow-up until March 31st, 2024.
Conclusions:
- The trial aims to provide robust evidence on the efficacy of community education for ACS.
- Findings will inform strategies for improving EMS use in regions with high ACS incidence and low prehospital care access.
- The study addresses critical public health needs in cardiovascular emergency response.
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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