1. ** KIM Division of Chronic Disease Control, Korea Centers for Disease Control and Prevention Study on a Pre-hospital project of Republic of Korea (ROK)-type HPH `RCCVC´ - Improving public awareness of Acute Myocardial Infarction(AMI) warning signs Study on a Pre-hospital project of Republic of Korea (ROK)-type HPH `RCCVC´ - Improving public awareness of Acute Myocardial Infarction(AMI) warning signs 22 nd International Conference on HPH 2014.4.23-25

2. Introduction - RCCVC  RCCVC  11 centers(1 center/region)  Budget : $10 million/center  Purpose  Decrease of mortality and disability due to cardio-cerebrovascular diseases (AMI, Stroke)  Similar to the second type among 4 types of HPH organizational approaches  Provides a comprehensive hospital-based disease management fit for these acute diseases  Pre-/in-/post-hospital services 2

3. Introduction - Structure and Major functions of RCCVC 3 Regional Cardiocerebrovascular Center -24-hours Residence of CP team -Development and operation of critical pathway (CP) -Installation of Stroke unit (SU) -Early rehabilitation within 48 hours -Cardiac rehabilitation -Building a cooperative system with subcenters and clinical networks at community -24-hours Residence of CP team -Development and operation of critical pathway (CP) -Installation of Stroke unit (SU) -Early rehabilitation within 48 hours -Cardiac rehabilitation -Building a cooperative system with subcenters and clinical networks at community -Inpatient man to man customized education -Inpatient small-group education by specialist -Follow-up service after discharge -Outpatient education -case management -Development of skilled manpower -Community preventive services -Inpatient man to man customized education -Inpatient small-group education by specialist -Follow-up service after discharge -Outpatient education -case management -Development of skilled manpower -Community preventive services Prevention and Management Center Prevention and Management Center Cardiovascular Center Cardiovascular Center Steering committee Steering committee Regional committee for cardiocerebrovascular disease management Regional committee for cardiocerebrovascular disease management Cardiocerebral Rehabilitation Center Cardiocerebral Rehabilitation Center Cerebrovascular Center Cerebrovascular Center

4. Purpose/Methods  Purpose  To evaluate the improvement of public awareness of AMI early symptoms  Methods  Study population : 9,600 persons  Sampling : proportional quota sampling by gender and age based on the 2010 census (aged 19 to 79 years)  Data collection  questionnaire (AMI early symptoms-early symptom 5 items, trick 1 item-, advertising exposure, major chronic conditions, etc.)  telephone-survey (RDD, Random Digit Dialing)  Statistical analysis : SPSS version 18 4

5. Results (1) 5 Pain or discomfort in the jaw, neck, or back Feeling weak or lightheaded Chest pain or discomfort Sudden trouble seeing (trick question) Pain or discomfort in the arms or shoulder Shortness of breath (%)  Recognition rate by symptoms  Chest pain and discomfort(79.1%) > shortness of breath(70.2%) > feeling weak or lightheaded(49.4%)

6. Results (2) 6  Number of symptoms (2011 vs 2012)  The rates of recognizing ≥1 symptoms : 86.3% → 88.7%  The rates of recognizing 5 symptoms : 10.3% → 10.9%  Exposure rate of advertising : 20.1% → 26.7%  No differences in the levels of knowledge on symptoms according to having chronic conditions 012345 No. of Symptoms (%)

7. Conclusions  To reduce the delay time from symptom onset to hospital arrival, public health efforts to improve awareness of AMI symptoms are essential  Public education efforts must continue and should focus on groups at risk of AMI in the community(and the hospital too)  This study was the first national and representative survey result to investigate AMI awareness in the general Korean public 7

8. Signs of a heart attack and ‘Call 119’ 8

9. Thank you for your attention 9