Education on Heart Attack and Emergency Medical Services Response in Areas with High Risk and Low EMS Utilization: A Stepped-Wedge Cluster-Randomized Study - Report - MDSpire

Education on Heart Attack and Emergency Medical Services Response in Areas with High Risk and Low EMS Utilization: A Stepped-Wedge Cluster-Randomized Study

  • By

  • Janet E. Bray

  • Ziad Nehme

  • Judith C. Finn

  • Jessica Kasza

  • Janelle Woods

  • Robyn A. Clark

  • Dion Stub

  • Dominique A. Cadilhac

  • Joosup Kim

  • Ben J. Smith

  • Susie Cartledge

  • Alison Beauchamp

  • Rhys Bowden

  • Natasha Dodge

  • Elizabeth Flemming-Judge

  • Clara Chow

  • Nicholas Cox

  • William van Gaal

  • Voltaire Nadurata

  • Peter Cameron

  • Heart Matters Investigators

  • Karen Smith

  • Tony Walker

  • Adam J Stormont

  • Amanda K Buttery

  • Roni Beauchamp

  • Erin R Bowen

  • Roslyn Cochrane

  • James Nigro

  • Donna N Koik

  • Alicja T Najbar-Kaszkiel

  • Nousa Sooriah

  • Anita Sterling

  • Georgie Ockenden

  • Elizabeth Cerini

  • Kelly E Donnelly

  • Jesse D Lewis

  • Ararso Olani

  • Kelly-Ann Jolly

  • April 27, 2026

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Education on Heart Attack and EMS Response in High-Risk, Low-EMS Use Areas

Overview

The Heart Matters trial evaluated a multifaceted community education campaign in eight high-risk local government areas (LGAs) in Victoria, Australia, aiming to improve acute coronary syndrome (ACS) knowledge and increase emergency medical services (EMS) utilization. The stepped-wedge cluster-randomized design targeted populations with historically low EMS use and poor symptom recognition, employing culturally tailored educational interventions.

Background

Acute coronary syndrome remains a leading cause of death and disability globally, with timely treatment being critical to outcomes. Patient delays in seeking care and underuse of EMS contribute to prolonged ischemic times and worse clinical outcomes. Barriers to EMS use include poor symptom recognition, underestimation of severity, cost concerns, and misconceptions about EMS. Prior community interventions have shown mixed results, highlighting the need to focus on high-risk populations with low awareness and EMS utilization.

Data Highlights

The trial was conducted in 8 high-risk LGAs representing approximately 17% of Victoria's adult population (~792,000 adults). The intervention was rolled out in a stepped-wedge design with clusters transitioning every 4 months. Educational materials were translated into the five most common languages in the LGAs, and multiple engagement strategies were employed, including in-person sessions, videos, mailouts, local media, and social media campaigns. Data collection included administrative and registry data, with follow-up extending to March 2024.

Key Findings

  • The intervention improved community awareness of ACS symptoms and personal risk in high-risk LGAs.
  • Targeted education increased knowledge about the importance of timely EMS use for chest pain.
  • Multifaceted delivery methods, including culturally tailored materials and local engagement, facilitated reach to diverse populations.
  • Use of local coordinators with healthcare backgrounds enhanced community trust and intervention uptake.
  • Randomization and stepped-wedge design allowed for practical implementation and minimized contamination between clusters.

Clinical Implications

Clinicians should recognize the importance of community-tailored education in improving EMS utilization among high-risk populations. Engaging local healthcare professionals and culturally appropriate materials can enhance symptom recognition and prompt treatment-seeking behavior. Such interventions may reduce prehospital delays and improve ACS outcomes in underserved areas.

Conclusion

The Heart Matters trial demonstrates that a targeted, community-based educational intervention can effectively increase ACS awareness and EMS use in high-risk, low-utilization areas. This approach offers a practical model for reducing treatment delays and improving cardiovascular outcomes at the population level.

References

  1. Heart Matters Trial Protocol and Results, 2025 -- Education on Heart Attack and EMS Response in High-Risk Areas

Original Source(s)

Education on Heart Attack and Emergency Medical Services Response in Areas with High Risk and Low EMS Utilization: A Stepped-Wedge Cluster-Randomized Study

  • by Janet E. Bray, Ziad Nehme, Judith C. Finn, Jessica Kasza, Janelle Woods, Robyn A. Clark, Dion Stub, Dominique A. Cadilhac, Joosup Kim, Ben J. Smith, Susie Cartledge, Alison Beauchamp, Rhys Bowden, Natasha Dodge, Elizabeth Flemming-Judge, Clara Chow, Nicholas Cox, William van Gaal, Voltaire Nadurata, Peter Cameron, Heart Matters Investigators, Karen Smith, Tony Walker, Adam J Stormont, Amanda K Buttery , Roni Beauchamp, Erin R Bowen, Roslyn Cochrane, James Nigro, Donna N Koik, Alicja T Najbar-Kaszkiel, Nousa Sooriah, Anita Sterling, Georgie Ockenden, Elizabeth Cerini, Kelly E Donnelly, Jesse D Lewis, Ararso Olani, Kelly-Ann Jolly

  • April 27, 2026

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