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Too Many Heart Attack Victims Don't Call 911


WebMD Health News

July 10, 2000 -- There's no mistaking what doctors call a "Hollywood heart attack" -- a man or woman clutches his or her chest and falls to the ground.

But when the symptoms are jaw pain, dizziness, sweating, and nausea -- or even mild chest and left arm pain -- many people either don't recognize that they're in serious trouble or don't want to believe it. They don't call an ambulance, and if they go to the emergency room, they are likely to drive themselves.

A survey in the July 11 issue of the journal Circulation reveals that of nearly 900 people seen in the hospital for chest pain, only about 23% used emergency medical service (EMS) transportation.

The combination of symptoms is confusing, says investigator N. Clay Mann, PhD. "The person thinks, 'Oh, this will pass; this is indigestion.' Or 'I just need to sit down for a while,'" he tells WebMD. Sometimes, too, people are embarrassed or afraid of making the wrong decision, and so they don't call for immediate help. People who took nitroglycerine, a commonly prescribed medication for patients with heart disease, were more likely to call an ambulance, leading Mann and his colleagues to believe that they were familiar with the symptoms and so knew what to do.

The authors surveyed 20 communities across the U.S. and found that even when people do realize they should go to the hospital, they still hesitate to call 911. Of those patients seen in emergency departments (EDs), about 60% had someone drive them to the hospital. Nearly 16% actually drove themselves.

"What people are missing is that the moment those paramedics arrive on their doorstep, treatment starts," says Mann, who is an associate professor at the University of Utah School of Medicine in Salt Lake City. "Oxygen, medications, monitoring, defibrillation [if their heart stops beating] ... are available immediately. And probably the most important point is [the paramedics] can call and warn the ED that [they're bringing in a person] with chest symptoms, so care on arrival is much quicker."

The authors also did random telephone surveys with nearly 1,000 people in the 20 communities and found that they were far more likely to call 911 for a family member or even a stranger who appeared to be having a heart attack than they would for themselves. This indicates that as bystanders, their intention was to do the right thing. However, a limitation of this survey was that the person answering the survey question was told the ill person was having a heart attack. There was no guesswork about symptoms.

The most troubling finding was that using emergency medical services was lower among people who called their doctors about their symptoms. Mann thinks it's likely these people were falsely reassured. It may be that "the phone call with the physician is reducing their anxiety to the point that they now can drive themselves. Or, the other option is that the physicians feel ... [that] they're well-versed in the patient's history, and they're saying, 'This is your third angina [chest pain] attack. Why don't you have your wife drive you in,'" Mann says. "I don't know which of those [possibilities] is true, but the cold hard facts are that 83% who called their doctor and ended up having a heart attack didn't call 911."

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