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Heart attack symptoms are ignored for too long

Many people still wait over 2½ hours to seek help for heart attack

Louise Prime

Wednesday, 10 November 2010

People are still waiting far too long before they seek medical help for symptoms that may indicate a heart attack, reducing their chance of survival, US research has shown – the median delay is 2.6 hours.

Women, non-white people, older people, smokers and those with diabetes were likely to delay the longest. People also tended to delay seeking help for longer during the day than at night, report the researchers in Archives of Internal Medicine.

Guidelines advise people to call the emergency services if their symptoms do not improve within 5 minutes. It was already known that medical treatment is particularly urgent for ST-segment elevation myocardial infarction (STEMI) because earlier treatment improves outcome, but it was unknown whether or not treatment delay affected non-STEMI outcome.

Researchers from Rochester, Minnesota, US studied data on 104,622 patients who presented with non-STEMI to 568 hospitals from 2001-06. This included patient demographic and clinical information, physician and hospital characteristics, medication histories and treatment regimens and outcomes.

Across the whole study period the median delay from symptom onset to arrival at hospital remained stable, at 2.6 hours. About 60% of people had delayed longer than two hours – and 11% arrived at hospital more than 12 hours after symptom onset.

People delay coming to hospital for about a quarter longer during weekdays (8.00am to 4.00pm) than during weekday nights and weekend nights (midnight to 8.00am). The authors speculate: “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.”

Delay times were not consistently or strongly associated with in-hospital mortality.

The authors conclude: “Long delay times are common and have not changed over time for patients with non-STEMI. Because patients cannot differentiate whether symptoms are due to STEMI or non-STEMI, early presentation is desirable in both instances.

“Interventions aimed at improving patient awareness of symptoms and responsiveness to seek care will likely need to target all patients at risk for myocardial infarction, and not just those who have individual risk factors (age, sex or diabetes) for longer delay time.”

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