Racial differences in seeking time-critical treatment for a heart attack

June 26, 2003

African Americans are far less likely to seek immediate treatment for a heart attack than non-Hispanic whites, according to a researcher at the University of Illinois at Chicago.

In a study of 239 heart-attack victims of both races, only 13 percent of African Americans came into the hospital within one hour, compared with 35 percent of non-Hispanic whites. On average, blacks waited well over three hours before seeking treatment, whereas whites delayed only two hours.

"Timing is absolutely critical," said Julie Zerwic, associate professor of medical-surgical nursing and the study's lead author. "If treatment starts within an hour after the onset of symptoms, drugs that reestablish blood flow through the blocked coronary artery can reduce mortality by as much as 50 percent. That number drops to 23 percent if treatment begins three hours later. The goal is to introduce therapy within two hours."

One key reason why individuals in the study -- both African Americans and non-Hispanic whites -- delayed treatment was that the symptoms they experienced didn't resemble those they had expected.

"Most heart attacks do not look at all like what one of my colleagues calls the 'Hollywood' attack -- the heart attack you see on television or in the movies," Zerwic said. "The symptoms are not necessarily dramatic. People don't fall down on the floor. They don't always experience a knife-like, very sharp pain. In fact, many people describe the sensation as a heaviness and tightness in the chest rather than pain."

Older African Americans in the UIC study, both men and women, also tended to delay seeking treatment, more so than younger individuals. And many of the men opted to treat themselves first before going to a hospital for emergency services.

"Often, people will lie down or use a heating pad to relieve the tightness they feel in the chest," Zerwic explained. "They may take some medicine and wait to see if that works. All these steps postpone needed treatment."

For non-Hispanic whites in the study, both men and women, delay in seeking treatment was linked with their tendency to contact their physician first.

"Patients will call their physician's office, describe their condition and schedule an appointment for the next day," Zerwic said. "Unfortunately, in the case of a heart attack, turning to your physician is not the right thing to do. People need to get to a hospital quickly."

Cardiovascular disease is the leading cause of death in the United States. Every year, more than 1.1 million Americans experience an acute myocardial infarction. More than 45 percent die as a result.
The UIC study, published in the current issue of Nursing Research, was funded by he National Institute of Nursing Research, one of the National Institutes of Health. Other investigators involved in the study were Catherine Ryan, assistant professor at UIC; Holli DeVon, assistant professor at Marquette University; and Mary Jo Drell, clinical nurse specialist at John H. Stroger Jr. Hospital in Chicago.

For more information about the UIC College of Nursing, visit http://www.uic.edu/nursing/.

University of Illinois at Chicago

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