Heart Attack and Angioplasty: A Public Education
Challenge This
week's JAMA contains an
important study about the relationship
of financial concerns to delay in seeking treatment for heart attack.
No surprise: people with no insurance tend to delay going to the
ER when they are experiencing symptoms of a heart
attack. Conversely those with full insurance are more likely to
go within two hours.
But what's most important to me about the study
is that while the fully-insured patients were more likely to
seek out timely treatment, almost 40% of them delayed going to the
hospital for more
than six
hours -- leaving them with a legacy of damaged heart muscle and future
heart failure -- needlessly!
Obviously,
it's not just money
keeping heart attack victims away from the ER. Do you know
someone who's had the symptoms of an MI and has tried to make-believe
they're experiencing something else: a pulled muscle? an acid stomach?
To be trite: denial
-- not
just a river in Egypt. You get the idea....
Of course, many times the onset of a heart attack does
not present as the classic crushing chest syndrome, where you grip
the heart and say, a la Redd Foxx, "Call 911!
I'm havin' the Big One!" Sometimes the symptoms are
subtle, like my relative who was sitting on our couch after
dinner one night, complaining of indigestion. It wasn't. It was a
heart attack.
Unluckily for him, it was 1972. It would be five years before the first
angioplasty would be done and another three before Geoffrey Hartzler decided
to open up his patient's artery with a balloon in the midst of an
acute infarction, miraculously stopping the heart attack in its tracks!
I wrote
recently about the evolution in the treatment of heart attack
since the days of Eisenhower.
I remember those days, as a kid in upstate New York, walking home
from school on a sunny weekday afternoon and seeing at least four
of my friends' fathers, sitting on their front porches in their rocking
chairs. I always wondered why these fathers didn't go to work
during the day like mine did. Heart disease was why. Four fathers,
just on my one block, had been struck down by a heart attack. They
could no longer work, could barely drive a car and they all died
in their 50's.
So perhaps this is what we all visualize
when we think "heart attack" -- it's an upheaval, a catastrophic
end to a life of work and play, sitting on the front porch and waiting....
Perhaps this is why people who suspect they may be having
a heart attack don't want to go to the hospital -- it's not going
to make a difference -- I'm done for already.
Except that's not the case at all today. As angioplasty
pioneer Dr. William O'Neill relates in the video
clip below, angioplasty has radically changed all
of this and has "taken the dread factor out of heart attacks." In
our interview, he actually characterized the experience of having
a heart attack treated today as "not so bad, perhaps a little more
than a cold."
An over (or under?) statement to be sure, but maybe,
if more people understood this, there would not be so many staying
away from
the ER. The ACC has done a great job with its "door-to-balloon"
initiative. But that's what occurs inside the hospital doors.
What needs to happen now is some significant public education to
get those patients knocking on the door outside for help!!