Development of a Surveillance Model for Patients at Risk of Heart Disease Using 3 Steps STEMI Alert with a Participatory Approach

Abstract

ST-elevation myocardial infarction (STEMI) is a critical condition requiring urgent coronary reperfusion, with the primary cause of mortality being pre-hospital delay. This Research and Development (R&D) study aimed to develop a proactive surveillance model for high-risk cardiac patients by integrating the primary care concept (1P 4C) and Orem’s Self-Care Deficit Theory with the "3 Steps STEMI Alert" concept. The research process consisted of 4 phases: 1) situational analysis, 2) model development, 3) model implementation, and 4) evaluation. The study was conducted between May 2025 and January 2026. The sample consisted of 400 moderate-to-high-risk elderly individuals in Uthumphon Phisai District, selected through purposive sampling. The research instruments included the RAMA-EGAT Heart Score assessment, a knowledge test, and a CPR skill assessment form, which passed content validity checks (IOC = 0.92-1.00) and demonstrated high reliability (KR-20 = 0.84, Cohen’s Kappa = 0.88). Data were analyzed using descriptive statistics and inferential statistics (McNemar test and paired t-test).

Situational Problem: According to the patient statistics from the Strategy and Planning Unit of Uthumphon Phisai Hospital in 2021-2022, the pre-hospital mortality rates of STEMI patients were as high as 11% (2 out of 18 cases) and 12% (3 out of 24 cases), respectively, due to a lack of proactive screening and patients' lack of knowledge regarding warning signs. The study results had model development: The developed model comprised 4 warning signs in the local dialect (Sa-Woi, Knock, Shock, and Wub) and 3 action steps (STOP, TALK, and CALL 1669) integrated with household pinning via a Geographic Information System (GIS). The outcomes after participating in the project, the sample group showed a statistically significant increase in their mean knowledge scores (t = -45.32, df = 399, p < 0.001) and a significant increase in the proportion of awareness for every item (McNemar test, p < 0.001). Furthermore, 90.00% of the sample correctly remembered the emergency number and reported incidents to 1669. The CPR skills among network partners were 90.00% accurate, and 100% of the high-risk group accessed EKG screening services. The target group's satisfaction with the model was at the highest level ( = 4.65). In conclusion, the "3 Steps STEMI Alert" concept, integrated with network partners, effectively enhanced knowledge, skills, and proactive service access. This success was attributed to the transformation of the service system from a passive to a proactive approach. However, due to the lack of a control group in this study, there is a limitation in conclusively determining that all the observed changes were exclusively caused by the newly developed model alone.