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April 17, 2010 -- 11:30pm EDT

Heart Attack and Angioplasty: A Public Education Challenge
Ambulance and hospitalThis 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!!

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