Reducing delay in patients with Acute Coronary Syndrome and other time-critical conditions: a systematic review to identify the behaviour change techniques associated with effective interventions

Barbara Farquharson (Corresponding Author), Purva Abhyankar, Stephan U. Dombrowski, Karen Smith, Shaun Treweek, Nadine Dougall, Brian Williams, Marie Johnston

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Background: Time to treatment in many conditions, particularly acute coronary syndrome is critical to reducing mortality. Delay between onset of symptoms and treatment remains a worldwide problem. Reducing patient delay has been particularly challenging. Embedding behaviour change techniques (BCTs) within interventions might lead to shorter delay. Objective: To identify which BCTs are associated with reductions in patient delay among people with symptoms or conditions where time to treatment is critical. Methods: Data sources: Cochrane Library, MEDLINE, EMBASE, CINAHL and PsycInfoStudy eligibility criteria: Intervention evaluations (RCTs, controlled clinical trials and cohort studies) involving adults (aged >18yrs) and including an outcome measure of patient delay up to Aug 2016.Study appraisal and synthesis methods: Potential studies were screened using a transparent, replicable process. Study characteristics, outcomes and BCTs were extracted from eligible studies. Results: From 39 studies (200,538 participants), just over half (n=20) reported a significant reduction in delay. 19 BCTs were identified plus 5 additional techniques with a mean of 2 (SD=2.3) BCTs and 2 (SD=0.7) per intervention. No clear pattern between BCTs and effectiveness was found. In studies examining patient delay specifically, 3 of 4 studies that included two or more BCTs in addition to the two most commonly used additional techniques reported a significant reduction in delay. Conclusions: Around half of interventions to reduce prehospital delay with time-critical symptoms report a significant reduction in delay time. It is not clear what differentiates effective from non-effective interventions although in relation to patient delay particularly, additional use of BCTs might be helpful. PROSPERO registration number: CRD42014013106.
Original languageEnglish
Article number000975
JournalOpen Heart
Issue number1
Publication statusPublished - Jan 2019



  • Acute Coronary Syndrome
  • Delay
  • behaviour change
  • psychology
  • education
  • acute coronary syndrome
  • delay: Behaviour change

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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