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Nearly Half of Fatal Heart Attacks Strike Outside Hospital

CDC calls figures 'alarming,' urges Americans to recognize symptoms

THURSDAY, Feb. 14, 2002 (HealthDayNews) -- You're lying in bed when suddenly your chest hurts, it's hard to breathe, and pain shoots down your arms.

Or perhaps you're experiencing annoying but seemingly less alarming symptoms: lightheadness, nausea or breaking out in a cold sweat.

Time to call 911 or head to the emergency room? Absolutely, because any of the above symptoms could mean you're having a heart attack, and time's wasting.

The Centers for Disease Control and Prevention (CDC) issued a report today saying too many people die of a heart attack outside a hospital because they fail to recognize the symptoms and seek immediate help.

According to the report in the CDC's Morbidity and Mortality Weekly Report, 63.4 percent of the 728,743 heart disease deaths in the United States in 1999 (the last year for which figures are available) were classified as "sudden." Moreover, the report says, 46.9 percent of those deaths took place outside a hospital, and another 16.5 percent happened in the emergency room.

The report blames the high out-of-hospital rate on the "unexpected nature" of sudden cardiac death and "the failure to recognize early warning symptoms and signs of heart disease."

"These high numbers of sudden deaths from heart disease, and the fact that they occur outside of the hospital, are alarming," CDC Director Dr. Jeffrey Koplan says in a statement.

According to the report, women (51.9 percent) were more likely than men (41.7 percent) to die of a heart attack before reaching a hospital.

Those figures agree with another new study, which says your age and racial background, as well as gender, may make you less likely to seek immediate help for a heart attack.

That second study says women, diabetics, the elderly and minorities are prone to show up at a hospital more than four hours after a heart attack.

The findings spell trouble because some powerful cardiac treatments lose their effectiveness in as little as three hours after a heart attack, experts say.

"The quicker you get in, the better off you are," says study co-author Dr. W. Brian Gibler, chairman of emergency medicine at the University of Cincinnati College of Medicine.

Since the 1980s, doctors have learned the importance of treating heart attack patients with medications within 30 minutes of their arrival at an emergency room, Gibler says.

Doctors have been influenced, in part, by the success of the medicine known as tissue plasminogen activator (tPA), which can break apart life-threatening blood clots. However, tPA is most effective when given within three hours of a heart attack or stroke, experts say.

"The doctors are treating patients more quickly, no question about it," Gibler says. "But the patients are not coming to the hospital as quickly as we would like."

To determine who's most likely to arrive late at the hospital, Gibler and his colleagues examined two international studies of heart patients, known by the acronyms GUSTO-I and GUSTO-III. The researchers limited their study to 28,000 patients in the United States.

The researchers found heart attack patients take an average of 84 minutes to get to the hospital, a figure unchanged from seven years ago.

The researchers then compared patients who arrived early -- within two hours of an attack -- to those who arrived late -- after four hours. Thirty-five percent of the late arrivals were women, compared to 27 percent of the early arrivals. Blacks constituted 6 percent of the late arrivals and 4 percent of the early arrivals, while diabetics made up 16 percent of the early arrivals and 25 percent of the late arrivals. In addition, the average age of the late arrivals was 64, compared to 60 for the early arrivals.

Arriving early has definite life-saving benefits. Nine percent of those patients who arrived at the hospital two or more hours after a heart attack were dead within a month; only 5 percent of those who arrived early died in that time.

Experts have several theories about why some people take longer to get to the hospital.

Diabetics are prone to a condition known as neuropathy, in which their nerves become less sensitive to some forms of pain, explains Dr. Eric J. Eichhorn, a cardiologist and professor of medicine at the University of Texas Southwestern Medical Center.

"The nerves do not transmit the [pain] message properly, so diabetics literally can be having a massive heart attack and little or no symptoms," he says.

As for women, their symptoms are different in some ways than those in men, and they may have a higher pain threshold. "In general, women are a little more stoic than guys," he says.

Gibler says his study suggests the delays among minorities may have to do with a lack of education. Educated minorities are more likely to seek treatment sooner, he says.

"Getting education to the patients is the key to this," he says. "We need to get the message to patients to come in more quickly."

The study results appear in the February issue of the Annals of Emergency Medicine.

What To Do

Don't ignore the the less recognizable signs of a heart attack, such as feeling lightheaded or having a cold sweat.

To learn the warning signs of a heart attack, visit the American Heart Association or

The National Heart, Lung and Blood Institute, along with the American Heart Association, have launched a new campaign to cut the sudden cardiac death rate. It's called Act in Time to Heart Attack Signs.

SOURCES: Interviews with W. Brian Gibler, M.D., Richard C. Levy professor, and chairman, Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati; Eric J. Eichhorn, M.D., professor, medicine, University of Texas Southwestern Medical Center, Dallas; Feb. 15, 2002, Morbidity and Mortality Weekly Report; February 2002 Annals of Emergency Medicine; Centers for Disease Control and Prevention news release
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