Many of these patients waited six hours or more, the study authors
wrote in the Journal of the American Geriatrics Society.
“The time that the heart is lacking much-needed oxygen also includes
the pre-hospital period, from the onset of symptoms to arriving for
medical care,” said study author Dr. Gregory Ouellet of Yale School
of Medicine in New Haven, Connecticut, in email to Reuters Health.
To improve heart attack outcomes, people need to be thinking about
the time before the patient gets to the hospital, and not just the
care in the hospital, Ouellet said.
Ouellet and colleagues analyzed data on 2,500 patients over age 75
who visited hospitals for heart attacks. They found that 1,053
patients, or 42 percent, experienced six or more hours of
prehospital delay. These patients were more likely to be nonwhite,
to have heart failure, and to have confusing symptoms that didn’t
include chest pain. Overall, 21 percent experienced atypical
symptoms - such as shortness of breath, weakness or fatigue,
shoulder or arm pain, indigestion and nausea – without chest pain.
“The finding that atypical symptoms is associated with delay makes
good intuitive sense and could easily help to form a public health
campaign similar to what has been done to raise awareness of heart
attack symptoms in women,” Ouellet said.
Women having a heart attack, for example, tend to experience
symptoms such as arm pain, jaw pain, lightheadedness and fatigue.
A public health campaign targeting older patients could clear up
misconceptions about what’s just indigestion and what’s not, said
Dr. Robert Goldberg of the University of Massachusetts Medical
School in Worcester, Massachusetts. Goldberg, who wasn’t involved
with this study, researches pre-hospital delay and its related
factors in Boston-area patients.
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“Studies have shown that patients who come to the hospital beyond
the 8- to 12-hour mark are less likely to be treated aggressively
because of the extent of the muscle damage,” he told Reuters Health
by phone. “When patients come earlier, physicians feel they can do
The study authors cautioned against applying the results to patients
who differ dramatically from those in the evaluation. For instance,
95 percent of the participants in this study lived within 30 miles
of a hospital. Hospital delay may differ significantly for rural
patients who live in isolated areas. This group also had a low level
of disability, whereas those with significant functional limitations
may face different difficulties with hospital delay.
“It’s important for the public, whether elderly or not, to know the
signs and symptoms of a heart attack and try to seek care as quickly
as possible,” Goldberg said. “When treated quickly, both acute and
long-term prognosis can be excellent.”
SOURCE: http://bit.ly/2zXWlcp Journal of the American Geriatrics
Society, online October 18, 2017.
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