Abstract
Objective: To create a mnemonic for acute coronary syndrome (ACS) warning symptoms and determine its diagnostic performance and effectiveness by comparing the proportion of participants correctly identifying warning symptoms of ACS and providing the correct planned response by utilizing emergency medical services (EMS) between the intervention group (who received education through an acronym) and the control group (who received education via conventional leaflets). Methods: The first phase of the study involves developing a mnemonic for recognizing warning symptoms of ACS through a retrospective cross-sectional analysis of patients presenting with suspected ACS symptoms in the emergency room of a university hospital. The efficacy of this mnemonic will then be evaluated in the second phase through a cluster randomized control trial involving individuals residing in Hat Yai who are at high risk of ACS. Results: The mnemonic with the highest diagnostic accuracy, "RUSH ChesT" (representing referred pain (R), unexplained sweating (U), shortness of breath (S), and heart fluttering (H) alongside chest pain (C), prompting timely (T) hospital visits), demonstrated a diagnostic odds ratio of 7.81 (5.93–10.44) and a sensitivity of 0.81 (0.77–0.85). Subsequently, it was accepted for publication in an international journal and translated into Thai. This version was then tested for efficacy compared to conventional health education via leaflets. The results revealed a significant increase in average knowledge scores regarding ACS warning symptoms post-test, with a concurrent decrease in median planned prehospital time following suspected ACS symptoms compared to pre-testing. However, when comparing the two intervention groups, there was no significant difference in increased average knowledge scores or decreased planned prehospital time between the control and intervention groups. In terms of transportation planning upon suspected ACS symptoms, participants in the intervention group notably favored using EMS, showing a significantly higher proportion compared to the control group, both immediately and during the six-month follow-up period. Conclusion: The diagnostic accuracy of the mnemonic created is quite impressive. When evaluating its efficacy in a high-risk population for ACS, the new educational method utilizing mnemonics proves more effective than conventional education via leaflet in prompting patients to contact EMS upon experiencing ACS warning symptoms. However, this method doesn't aid patients in recalling the warning symptoms, and both method equivocal in recognizing the need for immediate hospitalization. Suggestion: To further improve treatment outcomes for ACS, when providing health education to patients the additional measures should be implemented to help patients better remember warning symptoms of ACS, such as creating acronym that are easy to remember.
