Some patients not seeking rapid heart attack care

February 01, 2002

A new study finds the elderly, women, diabetic patients and minorities, who are experiencing symptoms of a heart attack, are more likely to experience delays in hospital arrival, and once in the hospital, delays in receiving treatment with thrombolytic (clot-busting) therapy. (Persistence of Delays in Presentation and Treatment for Patients with Acute Myocardial Infarction: The GUSTO-I and GUSTO-III Experience)

"Clot-busting drugs can stop some heart attacks and strokes in progress, reducing disability and saving lives," said W. Brian Gibler, MD, of the Department of Emergency Medicine at the University of Cincinnati. "But to receive the most benefit from these drugs, they must be given relatively quickly after heart attack symptoms first appear. To save more lives, these patient groups should be educated about the importance of rapidly seeking emergency care at the onset of heart attack symptoms. Once these patients arrive at the hospital, health care providers need to make sure they are treated promptly."

Researchers examined delays in hospital arrival and treatment in two large, multinational studies of nearly 28,000 patients who were experiencing symptoms of cardiac arrest and received fibrinolytic therapy. The studies, conducted seven years apart, include the 1990 trial, Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I), and the 1997 trial, Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO-III). The 1997 trial was conducted after the publication of national guidelines regarding the use of thrombolytic drugs and extensive public education on recognizing and rapidly responding to the early warning signs of a heart attack.

Researchers found, despite rigorous public education efforts, certain patients continue to arrive late to the hospital. These patients include the elderly (over age 64), and are more often women (35 percent), black (6 percent), and diabetic patients (25 percent). Between 1990 and 1997, treatment time once patients were in the hospital improved by 18 minutes (66 minutes to 48 minutes); however, patients' arrival time (84 minutes) to the hospital has not changed.

American College of Emergency Physicians

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