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Too Many Heart Attack Victims Don't Call 911

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He and his colleagues are planning another survey that will ask patients more specific questions about phone calls with their doctors.

The current study demonstrates that the public must be educated about when and how to seek treatment, according to David A. Meyerson, MD, a cardiologist at the Johns Hopkins Medical Institutions and a spokesman for the American Heart Association (AHA). "The AHA would like people to understand that there are perhaps 1.2 million heart attacks occurring in the U.S. each year, and only 950,000 make it to the hospital. So 250,000 are dying before they get [there]." The earlier you get treatment, the more likely you will avoid damage, he says.

"People are embarrassed," Meyerson says. "They don't want to come to the emergency room complaining of something and find it to be indigestion. They're afraid they made the wrong decision. If the symptom[s] ... look like it is cardiac-related, we should urge them to seek early treatment."

Prompt treatment also may make a dent in the in-hospital deaths. "We now have the ability to turn off a heart attack in midstream with clot-dissolving medications or angioplasty," which involves using a tiny balloon that is inflated to flatten the clot in the clogged vessel. These treatments can preserve heart muscle function, preventing heart failure and reducing deaths, he adds.

"Time is muscle," Meyerson says. "The longer you wait, the more heart muscle dies."

Although the survey didn't ask people directly whether cost was a factor in their decision to call 911, it was noted that in areas that had either state-supported emergency medical services or a subscription service, the service was used twice as often as in areas that didn't have it.

"Cost could be a part of it," says David E. Wilcox, MD, FACEP, a spokesman for the American Academy of Emergency Medicine Physicians. He points out that some managed care programs have denied coverage if it was later learned that the person didn't have a serious problem.

To combat this, now at least 32 states have passed legislation to define "emergency" based on a layperson's interpretation, and a federal bill seeks to do the same. "If you have signs or symptoms that you interpret to be a potential emergency, and you go to the ED to have it checked out, the insurance company must pay for it," says Wilcox in an interview with WebMD. Wilcox also is medical director of ConnectiCare and a practicing emergency room physician at St. Francis Hospital in Hartford.

It's important to get the "prudent layperson" definition of emergency through the federal legislature, says Wilcox, because under the Employee Retirement and Income Security Act (ERISA), large companies that are self-funded do not fall under state law. So even though 32 states have passed the statute, big companies that account for about 40% of all employees in the country don't fall under it, he says.

"If you have a service that is free to you, [cost] is not a roadblock to using it," says Wilcox.

For more from WebMD, read how to recognize an emergency.

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