Many Patients With Heart Attack Delay Hospital
MONDAY, Nov. 8 (HealthDay News) -- The time it takes for a
patient to get to an emergency room when experiencing the symptoms
of a heart attack have remained stubbornly high for the past
decade, despite efforts to fix that, researchers report.
A new study in the Nov. 8 issue of
Archives of Internal Medicine found that it took heart attack
patients an average of 2.6 hours to get to the hospital after first
noticing symptoms -- this despite education efforts to get people
to call for help or leave for the hospital within five minutes of
chest pain, jaw pain, shortness of breath or other symptoms.
Progress has been made in cutting system delays -- meaning what
happens after a patient enters into medical care -- with
"door-to-balloon" (such as angioplasty) times now well below 90
minutes, and sometimes as low as 50 or 60 minutes. Time is
especially critical for patients with a type of heart attack called
ST-segment elevation myocardial infarction (STEMI), which tends to
be the more severe form of heart attack.
Previous research has shown that the time from onset of symptoms
to arriving at the hospital for STEMI patients is about 114
minutes, or less than two hours, the study authors said.
The new study looked at non-STEMI patients.
"People have put in a lot of effort to reduce the time from the paramedic to getting to the hospital and into the cardiac cath [catheterization] lab where you open up the blocked vessels, and there's been great success with that," said Dr. Frederick Ling, director of the cardiac catheterization laboratory at the University of Rochester Medical Center in Rochester, N.Y. "The issue is that there really has to be a lot more focus now on the patient side, but the patient part of it is much harder to do."
Study lead author Dr. Henry H. Ting, an interventional
cardiologist with the Mayo Clinic in Rochester, Minn., said: "A
heart attack starts when you first develop symptoms, not with the
first medical contact. There's an upstream component when a patient
develops symptoms before they decide to call 911 or come into the
Ting and his colleagues analyzed data on more than 104,000
patients who had arrived at one of 568 hospitals with a non-STEMI
heart attack from the beginning of 2001 to the end of 2006. This
information was included in a national registry funded by several
pharmaceutical companies, although this study was not funded by
The median delay time of 2.6 hours did not budge during the
six-year time period. Fifty-nine percent of patients took more than
two hours to get to the hospital while 11 percent took 12 hours
after symptoms started.
Women, along with people who were older or non-white, who had
diabetes or were current smokers were the least likely to seek
And patients who arrived at the hospital during weekday and
weekend nights -- between 12 a.m. and 8 a.m. -- had 25 percent
shorter delay times than patients who arrived between 8 a.m. and 4
p.m. on weekdays, the investigators found.
But, the delays didn't seem to be associated with mortality, at
least with the non-STEMI patients in the study.
The study findings suggest that initial assumptions about the
cause of the delays -- that patients simply didn't know they were
having a heart attack -- may be wrong, the study authors said.
"There may be other reasons why patients delay," Ting said.
Previous studies have found that both an individual's trust in
the health-care system and their insurance status have influenced
when they call for help.
"It may not be, 'I don't know what the symptoms are,' but more, 'Do I trust the system?' and 'Can I pay for it?'" Ting said.
Another study, this one published in the November issue of
Archives of Neurology, found that patients with an ischemic stroke who receive and respond to the clot-dissolving drug recombinant tissue plasminogen activator (rt-PA) within an hour of their stroke tend to fare much better three months later.
But not all patients respond to rt-PA, and those patients may be
candidates for a different approach that uses rt-PA followed by
other clot-busting therapies.
The new findings suggest that using a simple measure of
neurological function at a patient's bedside may help decide which
patients are benefiting from rt-PA therapy and which ones need
additional medical measures, stated the study authors, from
Assistance-Publique-Hopitaux in Paris, France.
American Heart Association has more on how to
recognize the symptoms of a heart attack.
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