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 Among 474 U.S. patients who arrived in emergency departments with
dangerous reductions in blood flow to the heart, those whose
symptoms had come on gradually took up to six hours longer than
recommended to call for medical help and get to the hospital, the
researchers found.
Gradual symptoms were not recognized or taken seriously, despite
reflecting a medical emergency, and patients took up to eight hours
to get help compared with an average of 2.57 hours among those with
abrupt or sudden symptoms, the research team reported in the
European Journal of Cardiovascular Nursing.
The American Heart Association recommends that heart attack patients
receive care within less than two hours to provide the best chance
of avoiding permanent damage to the heart muscle.
In a sudden heart attack, patients have severe pain from the start.
But symptoms of a gradual attack - mild discomfort, breathing
trouble and tightness of the chest - are not so obvious, the authors
note.
"Heart attack victims must not worry their symptoms might be a false
alarm," said Dr. Sahereh Mirzaei of the University of Illinois at
Chicago, who led the new study. "Call 911 and get to the emergency
department quickly."
The authors analyzed data on patients participating in a larger,
multi-state study. The current analysis focused on 343 men and 131
women, ages 29 to 93, who were admitted to hospital emergency
department with what was later confirmed to be acute coronary
syndrome, which includes conditions that suddenly reduce blood flow
to the heart such as heart attacks and unstable angina.
Nearly half of the respondents, 44%, reported a gradual onset of
symptoms; the rest reported abrupt symptoms. And half of the
patients took four hours or more to get to the hospital.
Being uninsured and having gradual symptom onset were the factors
most strongly associated with a longer delay. Having sudden
symptoms, or symptom onset after exertion, were strongly tied to
getting to the hospital quickly.
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People with a heart condition, type 2 diabetes, high blood pressure,
or who are smokers, may be at greater risk and should be alert to
gradual symptoms, especially after physical exertion, Mirzaei told
Reuters health in an email.
"People with gradual symptoms don't describe what they are feeling
as pain, just pressure and tightness. Doctors must explain that
tightness and pressure are just as serious," said Dr. Ashish Jha, a
physician and professor at the Harvard T.H. Chan School of Public
Health in Boston, who wasn't involved in the study.
"The innovative part of this study was that the authors tried to
examine what slowed people down," Jha told Reuters Health in a phone
interview.
He agreed that part of the problem was how patients identified
symptoms. "Whenever there is a new symptom, a lot of people ignore
it or try to explain it away."
However, a bigger study with more patients and data would help
understand the issue better, Jha said.
Mirzaei noted that there are no public policies to reduce delays in
getting to hospitals by helping people recognize their symptoms and
seek help quickly.
"The American Heart Association advises individuals who think they
may be having a heart attack to call 911 immediately. Unfortunately,
approximately 50% of heart attack victims never call 911," she said.
"Symptoms may come and go, but heart disease does not. Know about
your symptoms and seek care immediately," Mirzaei said.
SOURCE: https://bit.ly/2kuN5KS European Journal of Cardiovascular
Nursing, online September 11, 2019.
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