NEW YORK (Reuters Health) - Despite expert recommendations to seek treatment if shortness of breath, chest discomfort and other telltale signs of a heart attack don’t improve after five minutes, a new study suggests that typical sufferers still stall more than two hours.
Heart disease is the leading cause of death in the U.S., with about 1.25 million heart attacks occurring each year and a quarter of patients succumbing to the event.
About half of all heart attack deaths occur within one hour — usually outside of a hospital.
“In the past decade, we’ve made dramatic improvements in how quickly we provide heart attack care,” lead researcher Dr. Henry H. Ting, of the Mayo Clinic in Rochester, Minnesota, told Reuters Health.
“But you can only do so much having an efficient system of care,” he added. “The next step is eliminating delays when people first develop the heart attack, which is usually at home or at the workplace.”
Ting and his colleagues studied more than 100,000 patients with a relatively mild form of heart attack — a non-ST-segment elevation myocardial infarction — in which a blood clot doesn’t completely block the affected coronary artery.
The researchers found that the average patient arrived at the hospital 2.6 hours after they first noticed symptoms, and 11 percent actually waited 12-plus hours before calling 9-1-1 or going to the hospital.
Older people, women, nonwhites, smokers and diabetics all tended to delay slightly longer, report the researchers in the Archives of Internal Medicine.
Patients experiencing a heart attack at night, on the other hand, sought care in about 25 percent less time than those who came to the hospital between 8 a.m. and 4 p.m.
The extended delays didn’t appear to affect patient outcomes - in part, the authors speculate, because the people with the most severe symptoms and therefore the highest risk of death were most likely to come in sooner.
Nonetheless, the team’s previous research found that the longer a patient stalled with an ST-segment myocardial infarction — the more serious form of heart attack in which a coronary artery becomes completely blocked off — the lower their chances of survival. The average delay among these patients was about two hours.
“A patient experiencing symptoms of a heart attack doesn’t know which kind they are having,” noted Ting. “All of these patients need to come in much faster.”
Further, the milder form can often evolve into the more severe heart attack over time, he added.
So, why have these delays persisted despite educational campaigns to inform people about the symptoms of a heart attack and the importance of seeking timely treatment?
“The fact that the greatest duration of delay in heart attack care is with the patient and not in the health care system goes beyond just an education gap or lack of awareness about symptoms,” said Ting. “More complex issues are involved and the solution is not going to be a simple one.”
In research published last year, for example, Ting and his team found that people without insurance or underinsured were more likely to delay heart attack treatment.
Other studies have found that a lack of trust in the health care system plays a part in patients stalling.
Ting suggests the need for a greater use of social marketing, including strategies similar to breast cancer’s pink ribbons, in order to reach more people.
“The only way we’re going to make a difference in outcomes is if we can get the system of care to everyone,” said Ting. “People need to actually access that system, otherwise the more effective and efficient care we’ve achieved will all be for naught.”
SOURCE: link.reuters.com/xeb64q Archives of Internal Medicine, online November 8, 2010.