(Reuters Health) - A significant proportion of older people having heart attacks put off going to a hospital, a recent study found.
Many of these patients waited six hours or more, the study authors wrote in the Journal of the American Geriatrics Society.
“The time that the heart is lacking much-needed oxygen also includes the pre-hospital period, from the onset of symptoms to arriving for medical care,” said study author Dr. Gregory Ouellet of Yale School of Medicine in New Haven, Connecticut, in email to Reuters Health.
To improve heart attack outcomes, people need to be thinking about the time before the patient gets to the hospital, and not just the care in the hospital, Ouellet said.
Ouellet and colleagues analyzed data on 2,500 patients over age 75 who visited hospitals for heart attacks. They found that 1,053 patients, or 42 percent, experienced six or more hours of prehospital delay. These patients were more likely to be nonwhite, to have heart failure, and to have confusing symptoms that didn’t include chest pain. Overall, 21 percent experienced atypical symptoms - such as shortness of breath, weakness or fatigue, shoulder or arm pain, indigestion and nausea – without chest pain.
“The finding that atypical symptoms is associated with delay makes good intuitive sense and could easily help to form a public health campaign similar to what has been done to raise awareness of heart attack symptoms in women,” Ouellet said.
Women having a heart attack, for example, tend to experience symptoms such as arm pain, jaw pain, lightheadedness and fatigue.
A public health campaign targeting older patients could clear up misconceptions about what’s just indigestion and what’s not, said Dr. Robert Goldberg of the University of Massachusetts Medical School in Worcester, Massachusetts. Goldberg, who wasn’t involved with this study, researches pre-hospital delay and its related factors in Boston-area patients.
“Studies have shown that patients who come to the hospital beyond the 8- to 12-hour mark are less likely to be treated aggressively because of the extent of the muscle damage,” he told Reuters Health by phone. “When patients come earlier, physicians feel they can do more.”
The study authors cautioned against applying the results to patients who differ dramatically from those in the evaluation. For instance, 95 percent of the participants in this study lived within 30 miles of a hospital. Hospital delay may differ significantly for rural patients who live in isolated areas. This group also had a low level of disability, whereas those with significant functional limitations may face different difficulties with hospital delay.
“It’s important for the public, whether elderly or not, to know the signs and symptoms of a heart attack and try to seek care as quickly as possible,” Goldberg said. “When treated quickly, both acute and long-term prognosis can be excellent.”
SOURCE: bit.ly/2zXWlcp Journal of the American Geriatrics Society, online October 18, 2017.