Heart attack patients taken directly to heart centres for lifesaving treatment have better long-term survival than those transferred from another hospital, reports a large observational study presented today at Acute Cardiovascular Care 20191 a European Society of Cardiology (ESC) congress. Directly admitted patients were older, suggesting that heart attacks in young adults, and particularly women, go unrecognised by paramedics and patients.
Study author Dr Krishnaraj Rathod, of Barts Health NHS Trust, London, UK, said: "The age of first heart attacks is getting younger, one of the reasons is because of lifestyle habits. The average age in our cohort is no longer 60, but around 40 years and we even see patients in their 30s. Directly admitted patients were sicker but they were also older, indicating that paramedics may think heart attack is unlikely in younger adults. My message to them is 'in cases of doubt, repeat the 12 lead ECG and consider speaking to the heart attack centre'."
People in their 30s and 40s should not ignore heart attack symptoms, particularly women who often have atypical symptoms, he said. "Younger patients likely wait longer to call for help because if they have chest pain, heart attack is not the first thing they think of. If you are in any doubt, phone an ambulance."
[...] Dr Rathod said: "Our findings indicate that the superior survival in patients admitted directly to a primary PCI hospital was because there was a shorter gap between calling for help and receiving treatment."
"All patients with STEMI should be admitted directly to a primary PCI centre within 90 minutes of diagnosis by electrocardiogram (ECG), which is done by ambulance teams," he said. "Yet in our study nearly one-third were taken to another hospital first, indicating that a STEMI diagnosis was not made until patients reached that hospital, and they then had to be transferred. However, it must be noted that the rates of transfer directly to a primary PCI centre were better in the later years suggesting better identification of appropriate patients by healthcare staff."
(Score: 2, Insightful) by Anonymous Coward on Tuesday March 05 2019, @03:00PM (1 child)
People with an emergency where every second counts have better chances if they are treated as soon as possible by people who know how to treat them correctly?
Did anyone seriously doubt that?
(Score: 3, Funny) by HiThere on Tuesday March 05 2019, @05:18PM
It's not that simple, though that's part of it. But taking the patient to a heart center can often take a lot longer.
OTOH, once I admitted my wife to a hospital, and they put her in the neurology department rather than the cardiac department. She was on her way out when I thew a major scene and got here transferred to the cardiac department. They knew how to care for her properly, and she recovered. (Well, after a few days she insisted on being transferred to a different hospital that knew her case well, but I was satisfied with the treatment and progress that she was making under the care of the cardiac department.)
Cardiac cases aren't always matters of "deal with this as quickly as possible", but can be matters of "keep those electrolytes in balance, and monitor the electronics". Of course, you need specialized knowledge to do that, but it's not a matter of seconds count, but rather of hour count...and you're got to handle it properly. The emergency room had placed her into the first available bed that was reasonably appropriate. (Well, she'd fallen and hit her head, so neurology wasn't wildly inappropriate...it was just inappropriate for her.) Note that this doesn't imply that she didn't have neurological problems. She did. But they weren't what was causing the collapse. But the neurologists looked at her and treated the neurological problems, and didn't even monitor the cardiac problems. Change wards and the situation was reversed. But even in the hospital where they knew her case well the cardiac department didn't communicate well with the neurology department, and that's probably a part of why she eventually died. (It was projected as "You'll die in about a decade, perhaps a bit less, so get ready.", but within a month she was transferred to a "long term care facility" that killed her. If I said how I feel about that place, I'd expect to be sued, because it was a torture chamber, and they replaced her actual medicines with fake pills, so she died within a week. They also had a policy of not noticing when she couldn't take her medicine, so she probably only even got the fake pills when I was helping. It looked like such a nice place on a short visit to evaluate it, too. It was on Alameda Island in the SF Bay Area, and the name of the place contains the name of the island, so avoid using places there that are built as 1 story buildings, and look 1960's modern.
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(Score: 1, Interesting) by Anonymous Coward on Tuesday March 05 2019, @03:39PM (2 children)
The most important thing here is that 40 is the old 60.... holy fuck... stop eating yourselves to death people.
(Score: 3, Interesting) by opinionated_science on Tuesday March 05 2019, @04:33PM (1 child)
and one of the causes - tooth decay.
Yes, if you have bleeding gums, stuff can get in and cause heart disease.
Remember all those movies where the drug dealers rub "der drugs" on their gums....
(Score: 0) by Anonymous Coward on Wednesday March 06 2019, @02:16PM
Except I expect people today to have better teeth than 50 years ago. You know, dental care and all that is more accessible. So this can't be it.
(Score: 4, Funny) by ikanreed on Tuesday March 05 2019, @03:47PM
Where else are you going to get a machine that goes "ping"?
(Score: 2) by Runaway1956 on Tuesday March 05 2019, @03:56PM (1 child)
people who get no treatment for their heart attacks generally don't suffer a second.
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(Score: 0) by Anonymous Coward on Tuesday March 05 2019, @10:27PM
Actually, they suffer several minutes.
(Score: 2) by All Your Lawn Are Belong To Us on Tuesday March 05 2019, @11:23PM
This is about European care. "Wait, there's a difference?" Sometimes yes, sometimes no. It's generally true in the U.S. also that heart attack goes less recognized in women than men. I can't speak to whether a "Heart Centre" is the same as an American "Heart Center" - it does seem to be more than just a cardiology unit or a cardiologist in the ER in both cases. Instead it looks like a hospital which specializes in cardiac care. There are such places in the US also, though I think you have to be in a major major city to find one. Maybe not.
I do know that in the U.S. there are many initiatives centered around getting a recognized myocardial infarction into a catheterization lab as soon as possible for angiogram and beyond care. (Just like strokes are prioritized to stroke labs in places they have them). And there's nothing wrong with European care or European centric stories... I'm just in the US.
But it's an EMT's dilemma: Do I get my patient to an ER that can handle an MI that is ten minutes away? Or do I drive twenty minutes to get them to the hospital with the cardiac center? 30 minutes? More? (And I don't know about Europe EMS, but in the US even most Basic-level ambulances often have 12-leads available on board. Paramedics can interpret 12-leads (dunno about Intermediates). Basics can read the doc-in-a-box text and transmit the strip to the hospital for interp - not much the basic can do anyway except push nitro, most places.)
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