Too many patients with certain types of heart attacks – ST-segment elevation myocardial infarction (STEMI) – are waiting too long between the onset of symptoms and getting medical help, say researchers in an article published in Archives of Internal Medicine. STEMI indicates a specific pattern on an electrocardiogram during a heart attack. Patients should call emergency services if heart-attack-like symptoms persist for more than five minutes, especially STEMI patients who need urgent treatment rapidly.
The problem is most patients cannot differentiate between a STEMI or non-STEMI heart a attack – so, they are told to get to hospital immediately, regardless of what type of heart attack they think they might be having.
The authors wrote:
For patients with STEMI, studies have documented that the average delay time from symptom onset to hospital presentation is two hours and has not decreased substantially despite multiple public education campaigns. While delays from symptom onset to hospital presentation have been linked to worse outcomes in patients with STEMI, the impact of such delays in patients with non-STEMI is unknown.
Henry H. Ting, M.D., M.B.A., and team gathered data on 104,622 non-STEMI patients from 568 patients around the country that had been taking part in a national study (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines, or CRUSADE), between 2001 and 2006. The data included demographics, clinical information, hospital characteristics, information on clinicians, medication histories, treatments used, and outcomes.
The median (midpoint) delay in arriving in hospital between 2001 and 2006 was stable at 2.6 hours. Approximately 60% of them had delay times of over two hours after the onset of symptoms, and 11% took over 12 hours. There was not a strong and consistent link between the risk of dying in the hospital and delay times, the authors added.
Longer delay times were more common among non-Caucasians, females, older individuals, smokers and patients with diabetes.
The authors wrote:
However, the magnitude of effect (
A 25% shorter delay time was detected among people who got to the hospital between midnight and 8am on weekdays or weekends, compared to those arriving between 8 o’clock in the morning and 4pm.
The researchers wrote:
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.
(conclusion) Novel strategies to improve patient responsiveness to seek care are critical and important for both patients with STEMI or non-STEMI.
Henry H. Ting, MD, MBA; Anita Y. Chen, MS; Matthew T. Roe, MD, MHS; Paul S. Chan, MD, MSc; John A. Spertus, MD, MPH; Brahmajee K. Nallamothu, MD, MPH; Mark D. Sullivan, MD, PhD; Elizabeth R. DeLong, PhD; Elizabeth H. Bradley, PhD; Harlan M. Krumholz, MD, SM; Eric D. Peterson, MD, MPH
Arch Intern Med. 2010;170(20):1834-1841. doi:10.1001/archinternmed.2010.385
Written by Christian Nordqvist