Impact of the "Warning Signs Campaign" on Characteristics of Patients Presenting with Acute Coronary Syndrome (ACS) to Hospitals

Objective: The National Heart Foundation's Warning Signs Campaign (2009-2013) aimed to raise awareness amongst the public of Acute Coronary Syndrome (ACS), encouraging people to recognise suggestive symptoms and seek immediate medical attention. This study explores the impact of the campaign on the characteristics of patients presenting to hospitals around Australia with ACS. Design: Retrospective cohort analysis Setting: 10 Australian Hospitals recruiting for the CONCORDANCE registry continuously throughout the campaign period. Participants: Patients presenting with ACS to hospitals before, during and after the campaign ran in their jurisdiction. Main Outcome Measures: Whether an ambulance was called, time between onset of symptoms to first medical contact, as well as time between onset of symptoms to primary percutaneous intervention or lysis. Results: Time to first medical contact did not improve during or post-campaign for NSTEACS medical hours (IQI) 1.6 (0.5-4.8) pre, 2.2 (0.7-7.6) during, 2 (0.7-6.9) post (p < 0.001) or STEMI, 1.1 (0.4-3.5) pre, 1.6 (0.6-5.1) during, 1.4 (0.5-4.3) post (p = 0.0113). In STEMI, time from symptom onset to pPCI (p = 0.256) and time to lysis (p = 0.387) were also unchanged. The proportion of ambulance arrivals remained stable (pre 55% vs. during 58%, p = 0.493). Patients presenting during the campaign were more likely to be born in Australia 56% pre, 69% during, 68% post (p < 0.001), to report English as a first language 67% pre, 84% during, 79% post (p < 0.001), and had lower likelihood of prior MI or revascularization but greater likelihood of cardiovascular risk factors compared to those presenting prior. Conclusion: Among patients with ACS, we detected no increase in proportion of ambulance presentations nor earlier presentations among NSTEACS or STEMI during the campaign. There was an increase in the proportion of patients for whom English was the first language and those without a prior cardiac history but with cardiovascular risk factors, suggesting that the campaign impacted preferentially on certain strata in the community.