Women, elderly wait longer for heart attack care

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Women, elderly wait longer for heart attack care

By Charnicia E. Huggins

NEW YORK, Feb 01 (Reuters Health) - Elderly individuals, females,

diabetics and minorities continue to experience delays in both arriving

at the hospital after having heart attack symptoms and receiving timely

treatment for those symptoms, according to the results of two studies

conducted over a 7-year period.

" Clot-busting drugs can stop some heart attacks and strokes in progress,

reducing disability and saving lives, " lead study author Dr. W.

Gibler, of the University of Cincinnati in Ohio, said in a statement.

" But to receive the most benefit from these drugs, they must be given

relatively quickly after heart attack symptoms first appear. "

To evaluate delays in hospital arrival and treatment, Gibler and his

colleagues analyzed data from two large, multi-center studies of the use

of clot-busting drugs in patients with blocked heart arteries. Together,

the studies covered the period from 1990 to 1997. Gibler and colleagues'

analysis included nearly 28,000 multinational heart attack patients.

Overall, patients' delay in hospital arrival after the initial onset of

heart attack symptoms remained consistent over the study period, the

investigators report in the February issue of the ls of Emergency

Medicine. After getting to the hospital, however, patients were treated

with clot-busting therapy nearly 20 minutes sooner in 1997 than they had

been previously.

Older individuals, females, minorities and patients with high blood

pressure or diabetes were more likely to see longer delays from symptom

onset to treatment, the report indicates. However, smokers and

individuals with high cholesterol had shorter wait times.

In-hospital deaths and deaths at 30 days after the heart attack were

more likely to occur among patients whose treatment was delayed by more

than an hour, according to the study findings.

" Part of (the explanation) is that the delay in getting to the hospital

then delays your getting treatment in the hospital, " Gibler told Reuters

Health. " If you arrive late to begin with, there tends to be more

discussion...because you're at the outside limit of where you derive

benefit from the drug. "

Noting the risk of bleeding in the head caused by the clot-busting

drugs, Gibler said that many physicians consider the medications to be

of less benefit if they are given 6 or more hours after the onset of

heart attack symptoms.

Both educational and symptom issues may be responsible for delays in

getting to the hospital for treatment, the researcher speculated.

For example, patients who were college graduates were more likely to go

to the hospital for treatment sooner than their less-educated peers, the

report indicates. Individuals with managerial or professional job

positions were also less likely to experience delays in hospital

arrival.

" Patients have to know that 'if I have symptoms, I am having a heart

attack--I need to be seen,' " Gibler said. Educated patients may also " be

able to articulate their symptoms better " once in the hospital, he

added.

In light of the findings, Gibler called for the dissemination of

educational materials in churches and senior citizen centers targeting

individuals most at risk of delayed hospital arrival or treatment.

The key is to " make sure the elderly population knows that there is good

treatment for heart attack, " he said.

" There are drugs for the treatment of heart attack...(that cause)

minimal damage, but you have to go to the hospital to get that therapy, "

Gibler added.

SOURCE: ls of Emergency Medicine 2002;39:123-137.