From Our 2010 Archives

Many With Heart Attack Symptoms Delay Care

Most People Wait 2 Hours or More After Heart Attack Symptoms Start to Seek Help, Researchers Say

By Jennifer Warner
WebMD Health News

Reviewed by Elizabeth Klodas, MD, FACC

Nov. 8, 2010 -- Most people with symptoms of a heart attack still wait more than two hours before seeking treatment, despite repeated public education campaigns urging people to seek urgent medical attention.

Guidelines recommend people call 911 if symptoms of a heart attack -- such as chest discomfort, shortness of breath, and discomfort in other areas of the upper body -- do not improve within five minutes.

Heart attacks come in different shapes and sizes. Getting heart attack treatment fast is especially critical for people with the most dangerous type of heart attack, known as an ST-elevation myocardial infarction (STEMI), which is usually caused by a sudden complete blockage of one of the heart arteries.

But researchers say it's impossible for most people to know from their symptoms alone whether they are having a STEMI or non-STEMI heart attack, and that's why it's important to seek prompt medical treatment.

Studies have shown that the average delay between the start of heart attack symptoms and arrival at the hospital for people with STEMI heart attacks has remained unchanged at about two hours in recent years, and longer delays lead to worse outcomes.

But researchers say less is known about the impact of such delays in people with non-STEMI heart attacks.

Heart Attack Treatment Delays Persist

In the study, published in the Archives of Internal Medicine, researchers looked at 104,622 people who had a non-STEMI heart attack from 2001 to 2006 and were treated at 568 different U.S. hospitals.

They found the average delay in arriving at the hospital after the start of heart attack symptoms remained unchanged between 2001 and 2006 at about two and a half hours. About 60% had treatment delay times of more than two hours, and 11% arrived at the hospital more than 12 hours after experiencing symptoms.

People who were older, female, nonwhite, had diabetes, or currently smoked were more likely to have longer delays.

In addition, the study showed that people who arrived at the hospital for heart attack treatment during weekday and weekend nights (between midnight and 8 a.m.) had 25% shorter delay times than people who arrived during normal business hours on weekdays (between 8 a.m. and 4 p.m.).

"While we cannot determine why patients decided to seek care more quickly at night, potential hypotheses include heightened fear during the night when patients may be alone at home, higher tolerance of symptoms during the daytime when a patient is active or at work, or a perception of shorter waiting times and less crowding in emergency departments during the night," write researcher Henry H. Ting, MD, MBA, of the Mayo Clinic in Rochester, Minn., and colleagues.

The authors conclude that "novel strategies to improve patient responsiveness to seek care" for heart attack symptoms are critical to minimize heart muscle damage.

SOURCES: Ting, H. Archives of Internal Medicine, Nov. 8, 2010; vol 170: pp 1834-1841. News release, American Medical Association.American Heart Association, "Warning Signs of Heart Attack."

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