Not Everyone Is Receiving Prompt Heart Attack Treatment
Dec. 9, 1999 (Atlanta) -- When it comes to receiving life-saving treatment for heart attacks, the elderly, African-Americans, and the poor often receive life-saving treatment later than others. The delays in receiving rapid care, says David C. Goff Jr., MD, are due to lack of education as well as demographic, cultural, and socioeconomic barriers. "Often it's lack of knowledge of symptoms or simply a lack of transportation," Goff tells WebMD.
Goff is an associate professor of public health sciences and internal medicine at Wake Forest University School of Medicine, in Winston-Salem, NC. He is the lead author of a study appearing in the December issue of the American Heart Journal summarizing the results of a study designed to reduce patient delay in receiving life-saving medical care. In this study, researchers examined the medical records of nearly 4,000 patients hospitalized for evaluation of heart attack symptoms in 20 communities.
The average delay before reaching the hospital was two hours, with one-quarter of patients delaying more than five hours. "Delay time was longer among non-Hispanic blacks than among non-Hispanic whites, longer at older ages, longer among Medicaid-only recipients, and shorter among Medicare recipients than among privately insured patients, and shorter among patients who used an ambulance," writes Goff.
It has been shown in other studies that for heart attack victims, time is of the essence. Steven Borzak, MD, who wrote an editorial accompanying the article, points to another study which showed the importance of rapid treatment. "Mortality rate reduction was 51% in patients treated within one hour of symptom onset and fell progressively for each [additional] time interval," writes Borzak, who is with the Henry Ford Heart and Vascular Institute in Detroit.
In an interview with WebMD, Goff says the delays, by and large, are not attributable to age or race discrimination as might be suspected. "The issue is more complex then that," he tells WebMD. "I suppose if you want to look at the societal forces that cause people to have poor education, low income, lack of access to knowledge and access to health care, there are certainly social inequalities out there."
Goff says the study showed that poor, uneducated white people had longer delays in getting to the hospital when having heart attack symptoms. "Still, I wouldn't argue if someone said racism, which caused the educational disadvantage, makes this worse among minority groups," says Goff.
Goff points to a previous study showing significant lack of knowledge of heart attack symptoms by these same groups. "Education is a large part of the answer," says Goff. "We need to get the word out about what realistic heart attack symptoms are, rather than people continuing to be under the misimpression of the Hollywood heart attack where someone grabs their chest and falls out of the chair."
Goff says there's also a need for more 911 and emergency medical transport systems across the country. "There are some communities that still don't have them," says Goff.
According to the American Heart Association, the most common warning signs of heart attack are:
- uncomfortable pressure in the chest
- unexplained feeling of fullness
- squeezing or pain in the center of the chest lasting more than a few minutes
- pain spreading to the shoulders, neck, or arms
- chest discomfort with lightheadedness
- unexplained sweating
- unexplained nausea
- unexplained shortness of breath
Less common signs are stomach or abdominal pain, dizziness, difficulty breathing, unexplained anxiety, weakness or fatigue, palpitations, or paleness.