Patients delay treatment for over 2 hours after heart attack--study

Medical experts advise calling 911 if the common symptom of a heart attack such as discomfort or crushing chest pain do not recede within five minutes.

Unfortunately, many patients, delay seeking medical attention and miss out on the optimal benefits which can be derived during the first hour from symptom onset.

This is vital for patients with ST-segment elevation myocardial infarction (STEMI). Such patients need more urgent treatment.

Lead researcher, Dr Henry H. Ting, MBA of the Mayo Clinic in Rochester, Minn. stated, "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."

Details of study
The researchers tracked 104,622 patients who had a non-STEMI heart attack between 2001 and 2006 and were treated in 568 hospitals in the United States.

The investigators collected clinical information of the patient, including physician and hospital characteristics, medicines prescribed, treatment regimens and outcomes.

An interesting highlight of the study was a 25 percent shorter delay in reaching hospital by patients during weekday and weekend nights (between 12 a.m. and 8 a.m.) as opposed to those who arrived between 8 a.m. and 4 p.m. on weekdays.

Revelations of study
Analysis of data revealed that delay in arriving at the hospital had not improved between 2001 and 2006 and remained 2.6 hours after symptoms of a heart attack began.

It was also noted that around 60 percent of patients had delayed their treatment for longer than two hours while 11 percent had reached the hospital after more than 12 hours of the onset of symptoms.

The delay in seeking medical attention was more pronounced in patients who were older, female, non-white, diabetics and smokers.

An interesting highlight of the study was a 25 percent shorter delay in reaching hospital by patients during weekday and weekend nights (between 12 a.m. and 8 a.m.) as opposed to those who arrived between 8 a.m. and 4 p.m. on weekdays.

Ting stated, "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."

Study implications
The cardiovascular disease is projected to emerge as the leading cause of death worldwide by the year 2020.

A significant number of individuals who delay seeking medical care develop potentially preventable complications.

A shorter interval between symptom onset and medical care is linked to better cardiac function which can reduce mortality and morbidity.

The authors concluded, "Novel strategies to improve patient responsiveness to seek care are critical and important for both patients with STEMI or non-STEMI.”

The report is published in the Nov. 8 issue of 'Archives of Internal Medicine,' one of the JAMA/Archives journals.