September 2001

From University of Pennsylvania

'Heart-sense' game passes early test: Players prove more likely to seek prompt help for heart attack symptoms

PHILADELPHIA -- A computer game developed at the University of Pennsylvania to encourage prompt medical attention in the wake of a heart attack appears to have passed its first test: A preliminary study has shown that the game rendered its players more likely to respond to symptoms by calling 911 or reporting to the emergency room in a timely manner.

Professor Barry G. Silverman, the creator of the Heart-Sense game, reports the promising finding in the September issue of the INFORMS Journal of Health Care Management Science.

Players of the game, which can be used on most personal computers equipped with CD-ROMs, find themselves encouraging citizens of an imaginary village to seek medical treatment for their heart attack symptoms.

"It's believed that people learn best by teaching others," said Silverman, a professor of systems engineering in Penn's schools of Engineering and Applied Science and Medicine and the Wharton School. "This study indicates that even the most rudimentary version of the Heart-Sense game improves the likelihood that patients will seek medical attention for symptoms of a heart attack."

This first study of the game's effectiveness involved 18 subjects who played at their homes or offices. The participants played four versions, ranging from a straightforward display of text on their monitors to a fully interactive version featuring conversations with virtual victims. In follow-up questionnaires, those who had played any of the four versions indicated they would be more likely to call 911 or see a doctor in the event of an actual heart attack, with those who had played the most interactive, realistic version registering the strongest gains.

"Initial results show that users of the game exhibit a significant shift in intention to call 911 and avoid delay ... as well as a better understanding of both symptoms and of the need to manage time during a heart attack," wrote Silverman and co-authors Ransom Weaver of Penn's School of Engineering and Applied Science and John Holmes, Stephen Kimmel, Charles Branas and Doug Ivins of the Center for Clinical Epidemiology and Biostatistics at Penn's School of Medicine.

Cardiology researchers have documented that inaction in the face of heart attacks is a serious problem, with different studies placing the average delay at anywhere from two to 12 hours. It has been estimated that 26 to 44 percent of the 1.25 million Americans who suffer heart attacks annually delay more than four hours in seeking care. Certain groups appear more prone, including women, African-Americans and those in lower socioeconomic strata who may fear the costs associated with medical treatment.

Delays lead to increased morbidity and mortality because the most potent treatment, a class of drugs called thrombolytics that prevents the atrophy of cardiac muscle, is most effective if administered within 60 minutes. After six hours of delay, thrombolytics' benefits are virtually nonexistent.

"Dr. Silverman has developed a very promising new approach that will help us save lives by changing the health-seeking behaviors of our patients and their families," said Rose Marie Robertson, professor of medicine at Vanderbilt University and president emerita of the American Heart Association. "The American Heart Association and the National Heart, Lung, and Blood Institute are currently focusing major efforts at educating the public about the warning signs of heart attack and stroke and encouraging them to think through a plan of action before the event occurs. Heart-Sense employs current learning theory in an extremely user-friendly system. I believe that it can make a real difference."

The 15-minute game begins with a conversation with an emergency worker who has just responded to a community member experiencing severe chest pains, followed by a doctor explaining what happens during a heart attack and what the most common symptoms are. Players then enter a fictitious village, where they encounter people experiencing chest pain but saying things like, "I don't want to rush. If it gets worse, I will do something about it."

Cheered on by a heart-shaped character named Bea and a ticking clock emphasizing the need for quick action, it's the job of Heart-Sense players to encourage such reluctant figures that they should seek medical attention without delay. Heart-Sense is only the second game reported to alter health decisions, joining a game developed to educate college freshmen about drinking responsibly.

The game has been favorably reviewed by the American Heart Association, and when completed may be offered on that group's web site. It could also be installed in libraries, public health clinics and long-term care facilities, Silverman said. "Ideally, we'd like every doctor to hand this game to every patient who is at risk of a heart attack," he said.

Several additional studies of Heart-Sense's efficacy, one involving 260 subjects, are now underway. Silverman's team has been developing the game for roughly two years, funded by the National Heart Attack Alert Program of the National Institutes of Health and the National Library of Medicine.












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