Quick action key to reducing heart attack toll

Patients need to know that heart attacks aren't always accompanied by the crushing chest pain of a "Hollywood heart attack."

By Susan J. Landers, amednews staff. Oct. 1, 2001.

Washington -- Physicians are being strongly urged to explain to patients the importance of receiving prompt medical attention if they suspect they are having a heart attack.

"Physicians can greatly reduce death and disability among heart attack patients by educating them about the symptoms of a heart attack and motivating them to call 911," said David Faxon, MD, president of the American Heart Assn.

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The two major treatments for acute heart attack -- clot-busting medications and primary angioplasty -- are most beneficial when administered within the first hour after the onset of symptoms, Dr. Faxon said.

Dr. Faxon, chief of cardiology at the University of Chicago Hospitals, was appearing at a joint Sept. 10 news conference with National Heart, Lung and Blood Institute Director Claude Lenfant, MD, and Bruce MacLeod, MD, chair of the Dept. of Emergency Medicine at Mercy Hospital in Pittsburgh. Dr. MacLeod was representing the National Assn. of Emergency Medical Services Physicians.

They were announcing the start of "Act in Time to Heart Attack Signs," a new campaign to enlist physicians' help in educating patients about heart attack risk and survival.

The campaign was designed to try to alter statistics that show only one in five patients gets to a hospital emergency department in time to take advantage of the major advances in heart attack treatment.

Most patients wait for two to four hours before seeking help, said the groups, and this delay is a major factor in the nearly half million heart attack deaths in the U.S. each year.

Twice the number of patients died when they received clot-busting medication four to six hours after the onset of heart attack symptoms compared with patients who received the treatment within one to two hours, Dr. Faxon said.

Another study found that the three-day mortality rate for inpatients who underwent primary angioplasty within one hour of arriving at the hospital was just 1%. That figure compares with a three-day mortality rate of 6.4% in those who underwent the procedure more than 90 minutes after hospital arrival, he said.

Reasons for delay

Patients provide a range of reasons for their failure to act when symptoms first appear. Some people are unaware of heart attack symptoms. The average respondent to a National Heart, Lung and Blood Institute study could identify only three of 11 heart attack symptoms.

Most people's information on heart attacks comes from movies and television, Dr. MacLeod said. The "Hollywood heart attack" involves sudden, crushing chest pain, he said. "But the fact is, most heart attacks don't fit that image."

Patient delay is also attributed to embarrassment if the symptoms prove to be a false alarm. And the NHLBI found that people were more likely to recognize the benefit of calling 9l1 for others who might be having a heart attack than for themselves.

Eighty-nine percent of people surveyed in the institute's large "Rapid Early Action for Coronary Treatment" study, or REACT, said they would call 911 if they witnessed a person having a heart attack.

But a separate survey of patients who came to the hospital with chest pain revealed that only 23% had called 911. A surprising 16% even drove themselves to the hospital.

Many of the patients said they delayed calling 911 because they took aspirin or attributed symptoms to heartburn and took an antacid instead.

The American Heart Assn. also has instituted Operation Heartbeat, a program intended to reduce the time between the onset of symptoms and treatment.

Physicians should remind patients regularly that coronary heart disease is the No. 1 killer of both men and women, Dr. Faxon said. A recent heart association survey found that women in particular are not getting the message, and many still believe that cancer is their leading health threat.