Warnings could help cut heart deaths

SURVIVAL FROM heart attacks could be trebled if people were told in clearer terms how to deal with them, medical researchers say. The myth that heart attacks are always dramatic events in which the victim goes "aahh" and dies needs to be dispelled so that sufferers can identify the symptoms indicating the start of an attack and seek help quickly.

A study of 3,500 men and women who had heart attacks in Brighton, Sussex, South Glamorgan, and York in 1994 and 1995 found that threequarters of the 1,500 who died did so before reaching hospital. Among those under 55, 27 per cent died but once patients reached hospital this fell to 3 per cent, a ninefold reduction.

About 333,000 people have a heart attack in the UK each year. Dr Robin Norris, consultant cardiologist at the Royal Sussex County hospital, Britghton, says in the British Medical Journal that hospital treatment for heart disease has improved greatly in the last 20 years but death rates outside hospital remain high.

Overall survival might be trebled if patients and bystanders knew what to do during an attack, and if ambulances responded more quickly.

In many cases heart attacks begin slowly with a pain not unlike indigestion spreading to the arms and neck and accompanied by sweating, nausea, and breathlessness. However, patients confuse these symptoms with those of over-indulgence, viral infection or general fatigue.

In a separate study in the BMJ, Professor Michael Calnan and colleagues of the Centre for Health Services Studies, University of Kent, investigated 43 patients who had heart attacks, half of whom delayed more than four hours before seeking medical help. Most of those who delayed did so because they did not realise they were having a heart attack.

One man complained of feeling unwell to his wife and mother-in-law and they all decided it was indigestion. He took a tablet but the discomfort did not wear off so he had a glass of lemonade and when there was still no improvement he sucked a mint.

Professor Calnan said: "Those that went to hospital promptly had similar symptoms to those who delayed seeking help but they had a broader understanding of what a heart attack involved. The delayers felt it wasn't what a heart attack should be like."

There was a risk that people might call ambulances out unnecessarily if they confused ordinary episodes of indigestion with heart attacks but Professor Calnan said this had to be balanced against the likely saving of life. "One sufferer told us he was very concerned about wasting NHS resources. It is very difficult for patients."

A third study in the BMJ shows that for women, smoking raises the risk of a heart attack by 50 per cent more than it does for men. Danish researchers who studied 24,000 people over 12 years say this could be because women are more sensitive to the harmful effects of smoking, as a result of the interaction between components of tobacco smoke and hormonal factors.