Letter to the editor Health Promotion to Reduce Delays in Seeking Medical Attention in Patients With Acute Coronary Syndrome. Response

To the Editor,

We appreciate the comments of Moreno-Martínez et al concerning our article published in Revista Española de Cardiología.¹ In that study, we demonstrated the importance of the delay in seeking medical attention (DSMA) as the period of time that most influences total ischemia time. Given that a decrease in time-dependent morbidity and mortality has been shown in patients with ST-segment elevation acute coronary syndrome who undergo primary percutaneous coronary interventions, the main objective of acute ischemic heart disease care networks is to reduce these times.^2–4 Although published series have demonstrated that DSMA is the major determinant of total ischemia time, most of the efforts of care networks are focused on reducing the time between the call for attention and reperfusion.^2–4 The general population has little knowledge of the symptoms consistent with acute coronary syndromes.⁵ In addition, there are discrepancies concerning the efficacy of public awareness campaigns focusing on symptom recognition and the importance of an immediate call for medical assistance.⁶ The results of an intervention campaign, the “Salva una vida” (Save a Life) project, which was recently conducted in Catalonia, in northeastern Spain, in conjunction with the European “Stent for Life” initiative, are pending analysis. In our study, we identified 3 major groups—older patients, women, and diabetic patients—that should be the focus of these strategies.¹ Thus, we agree on the need to carry out primary prevention campaigns, with the indispensable collaboration of family medicine physicians, aiming not only toward the essential control of risk factors, but also toward making populations at high risk for DSMA aware of the need to call for assistance immediately after recognizing symptoms consistent with acute ischemic heart disease. We hope that future studies will shed light on the best way to achieve the effective implementation of these strategies in the general population.