Nov. 10, 1998 DALLAS, Nov. 9 -- The amount of time people delay in deciding to seek care for heart attack symptoms may be declining.
This is a key finding from the Rapid Early Action for Coronary Treatment, or REACT, trial presented today at the American Heart Association's 71st Scientific Sessions.
The study, funded by the National Heart, Lung, and Blood Institute, tested community campaigns to reduce the time people delay seeking emergency care for heart attack in 20 medium-sized cities in five regions of the country. The 18-month campaign was conducted in half the cities, and the other half served as controls in the 22-month study.
"A number of studies since the 1980s have shown that educational programs can shorten the time people delay in calling emergency medical services and hospital emergency departments," says Russell V. Luepker, M.D., who presented the study results in a plenary session. "But this is the first to show marked improvement in patient delay all across the country."
During the 1990s, median delays had been between three and four hours -- half the individuals delay longer and half delayed less than three to four hours. The REACT study examined the influence of media campaigns in educating the public about heart attack symptoms and the need for rapid action. Programs for heart professionals and people at high risk for heart attack were included with general community intervention. The study was conducted in 20 cities in 10 states including Alabama, Louisiana, Massachusetts, Minnesota, North Dakota, Oregon, South Dakota, Texas, Washington and Wisconsin.
REACT found median delay of 2.2 hours, far lower than most U.S. studies have found.
"That's very good news," Luepker, says. "It shows that there is now likely significant improvement in patients seeking care earlier."
Although the REACT campaign was unable to shorten patient delay further, the study saw an rise in the number of people with heart attack symptoms coming to the emergency department in the intervention cities and an increase in the number choosing to call EMS/911 for transport.
"People with heart attack symptoms in the intervention cities used EMS 10 to 15 percent more than in the other cities," Luepker notes. "That's important because in most U.S. cities, between half and two-thirds of those with a possible heart attack arrive some other way." EMS use improved particularly among women, says Luepker, chairperson of the REACT study's national steering committee and head of the division of epidemiology at the University of Minnesota School of Public Health.
"This was an important finding because, as we saw in our public telephone surveys, most people don't think of women as vulnerable to heart attacks even though heart disease kills more women than any other disease," he says. Women's risk for heart attacks was one of the six themes emphasized in the 18-month campaign. The other themes were general awareness of heart attack symptoms; heart attack survival plan; symptom recognition; bystander response to heart attack; and the importance of contacting EMS/911.
Luepker says denial and confusion about heart attack symptoms are major reasons why many individuals delay seeking emergency care. "People may rationalize. They may take an antacid and think the pain will go away in 15 minutes," he says.
"While most people recognized the chest pain as a symptom, they often think in terms of a 'Hollywood heart attack' like you see in the movies -- people clutch their chests in sudden pain and collapse," he says. This happens sometimes, but most heart attacks occur slower and more gradually.
Other factors often linked to delays in seeking help include old age, being female, lower socioeconomic status, and having mild or unusual symptoms. "The sooner people seek treatment, the greater their chances of surviving and reducing damage to the heart," he says.
According to the American Heart Association, the warning signs of heart attack are: uncomfortable pressure; fullness; squeezing or pain in the center of the chest lasting more than a few minutes; pain spreading to the shoulders neck or arms; chest discomfort with lightheadedness; fainting, sweating; nausea; or shortness of breath.
Less common signs are stomach or abdominal pain; dizziness; difficulty breathing; unexplained anxiety; weakness or fatigue; palpitations; cold sweat; or paleness.
Because the study was large and distributed over a wide geographic region, Luepker says more data from the REACT project will be forthcoming.
The AHA has a new program to promote early diagnosis and treatment of heart attacks called Operation Heartbeat. This new, multi-faceted program involves community volunteers and staff working to identify ways to improve the local "chain of survival." Strengthening the "chain of survival" will be accomplished through a variety of activities chosen after assessing each link to identify priority areas for improvement.
Co-authors are Mickey Eisenberg, M.D., Ph.D. Henry Feldman, Ph.D.; John Finnegan, Ph.D.; David Goff, M.D., Ph.D.; Robert Goldberg, Ph.D.; Jerris Hedges, M.D. Stavroula Osganian, M.D.; Michael Proschan, Ph.D.; James Raczynski, Ph.D.; Denise Simons-Morton, M.D., Ph.D.; and Jane Zapka, Sc.D.
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