When describing their heart attacks, many survivors recall uncertainty rather than panic.
Many of them don't even know they're having an attack until they get to the hospitaland that's OK: Experts say it's exponentially better to err on the side of caution and get to a hospital quickly.
Incredibly, one study of patients who had suffered a heart attack found that more than half did not immediately call an ambulance.
Women respond more slowly
Women are more likely than men to delay seeking treatment at the first signs of a heart attack, a behavior pattern that has puzzled cardiologists and contributes to the higher mortality rate from heart attack among women.
When researchers at Oregon Health & Science University in Portland looked more closely at this trend by interviewing heart attack survivors, they found some surprising results. Nearly a quarter of the women they interviewed downplayed the severity of their symptoms during their attack, and a fifth of them chalked up their symptoms to something other than a heart attack. One woman said she was reluctant to go to the emergency room because she thought the hospital staff would tell her she was "wasting their time."
While heart attack care has come a long way, says Anne G. Rosenfeld, PhD, lead author of the study, "We need to do more to educate people about the consequences of delaying treatment."
Female, nonwhite, and poor patients are more likely than other patients to wait six hours or more before seeking help for a heart attack, according to a study of elderly Medicare patients led by a Georgetown University researcher.
According to J. Willis Hurst, MD, a cardiologist at Emory University, treatment delay is a public health issue that needs to be addressed. "Rather than repeated advertisements about gastrointestinal reflux, how about advertisements about MI (myocardial infarction)," Dr. Hurst has said.
Finding the best cardiac hospital
During a heart attack, go to the nearest hospital. After immediate treatment, it's often a good idea to transfer to a hospital with better heart facilities. In 2005 the Centers for Medicare & Medicaid Services launched Hospital Compare, a website that tracks the quality of heart attack care at hospitals across the country.
The site doesn't give overall scores, but it does show how often a hospital follows standard practices. With a few clicks, you can find the percentage of heart attack patients who receive angioplasty within 90 minutes of arrival.
You can also find the percentage of patients who go home with a prescription for a beta-blocker, another sign of quality treatment.
The site won't explicitly tell you which hospital is best, but you can compare them side by side and come to your own conclusion.
Time is muscle
"The longer a person waits to get help, the greater the chance that the heart will suffer damage," says Richard O'Brien, MD, an emergency physician at Moses Taylor Hospital, in Scranton, Penn. Treatments for heart attacksincluding clot-busting drugs and balloon angioplastyare most effective in the first hour postattack.
"Doctors," he says, "have a saying: 'Time is muscle.'" Waiting can even be fatal. About half of all heart attack deaths occur before a person reaches the hospital.