Knowledgeable Patients Ignore Chest Pain

Oct. 7, 2009 -- When it comes to seeking treatment for chest pain, education doesn't always mean people do the right thing.

In a new study, heart patients who received counseling about heart attack symptoms and when to get treatment were no more likely to get immediate care than those who had not received counseling. This is disappointing because patients who receive care within 90 minutes after the onset of heart attack symptoms fare much better.

The study, published in Circulation: Cardiovascular Quality and Outcomes, included 3,522 patients with documented heart disease. Patients had a mean age of 67 years; two-thirds were men. About half of the patients received counseling. During the next two years, 565 of the study participants were admitted to the hospital with chest pain symptoms. Some were admitted more than once.

Even after learning the value of getting to the hospital quickly and using the emergency medical system (EMS), the group that received counseling was not significantly more likely to do these things than the comparison group that didn't get counseling.

The delay time -- the time between symptom onset and the hospital visit -- was 2.2 hours for the group that got the counseling and 2.25 hours for the group that didn't get the counseling. The counseled group used the emergency medical system 63.6% of the time, compared to 66.9% for the group without the counseling.

The only good news? The group that got counseling was more likely to take an aspirin and was more likely to call the emergency medical system if chest pain occurred within six months of the counseling.

In an accompanying news release, Alice Jacobs, MD, past president of the American Heart Association and professor of medicine at Boston University School of Medicine, listed common reasons that patients resist seeking care:

• Fear the incident will be an embarrassing false alarm
• Not wanting to "bother" care providers
• Concern that insurance won't cover emergency care

"This study again underscores the importance of ongoing research in this area targeted at finding what will change the behavior of patients and the public at high risk for coronary events," Jacobs said in a statement.