Treatment for heart attack is standardized and all medical professionals who work in emergency rooms know the procedure. Yet disparities can arise depending on factors that range from the race of the patient to the day of the week he or she is hospitalized.
Rene Colwell, 52, of New York City, who had her heart attack this year, says she spent a day feeling "not quite well," but it didn't occur to her that it could be her heart until she felt sharp pain in both of her elbows. "It's odd, I know, but I figured arm paineven if it's just elbowsmeant there might be something wrong with my heart."
She called 911, was whisked to the emergency room, got triaged to the front of the line and was given care that left her with little damage to her heart. "The response was so efficient it was almost not dramatic," she says. "I guess if you have to have a health emergency, a heart attack isn't the worst one to have."
Deb Kautz, 46, of Zumbro Falls, Minn., describes emergency treatment for a heart attack as surprisingly calming and even relieving. As the doctors snaked a catheter through her veins and opened the clogged artery, she felt alert, then energized. "My husband said, 'Of course you feel different, your heart's finally getting the blood it needs.'"
Medications can instantly reduce pain. Balloon angioplasties open arteries blocked with plaque, restoring the flow of lifesaving blood and oxygen to the heart. Clot-busting drugs can also help. The right treatment gives many heart attack patients their first opportunity to think that they just might survive.
Different standards of treatment
Heart attack treatment isn't so rosy for some groups. Stephen Kopecky, MD, a cardiologist at the Mayo Clinic in Rochester, Minn., has pointed out that there are gaping racial disparities in care for heart patients who are African American, according to 68 out of 81 studies on race and cardiac care. Even wealthier people of color may receive less aggressive care.
"African Americans are less likely than whites to receive catheterization, angioplasty, surgery, and thrombolytic therapy," Dr. Kopecky told a gathering of the American College of Cardiology in 2005, adding that this pattern "tugs at all our ethical standards."
Have your attack during the week
And pity the person who suffers a heart attack on Saturday or Sunday. They're less likely to survive, mainly because weekend admission is associated with lower use of invasiveand lifesavingprocedures.
That's not news to malpractice attorney Leon Aussprung, a former physician who has handled scores of cases where patients have died of heart attack or suffered brain injuries because they didn't get proper care in the emergency room. "The standard of care for treating a heart attack is well established, but it is not always followed," he says. Aussprung cites a 45-year-old woman who went to the hospital complaining of chest pains and died while waiting for treatment, possibly because she was not a traditional older male heart patient.
"Once you're at the hospital, it matters if anyone cares if you die," says Dr. Kopecky. "There was a study that asked heart disease patients, 'Does anybody care if you're alive?' If they said no, their chances of dying went up fivefold."