News Release

People are more likely to call 911 for others, but delay calling for their own heart attack symptoms

Peer-Reviewed Publication

American Heart Association

DALLAS, July 11, 2000 -- People recognize the benefit of calling an ambulance if they witness someone else having possible heart attack symptoms, but individuals personally experiencing the same symptoms often choose not to use emergency medical services (EMS), according to a study in today's Circulation: Journal of the American Heart Association.

"Little is known about a patient's decision to use emergency transportation when they are experiencing chest pain," says N. Clay Mann, Ph.D., M.S., an associate professor at the University of Utah School of Medicine in Salt Lake City. "With this study, we wanted to determine if community members realized the benefit of using EMS during a cardiac emergency, then contrast these findings with actual EMS use." The study was conducted at the Oregon Health Sciences University department of emergency medicine in Portland.

Of the 1.1 million Americans who experience a coronary attack each year, more than half die before reaching a medical facility. Early treatment is critical, says Mann. Clot-busting drugs and other therapy can reduce the chance of death from a heart attack by 25 percent if given soon after the onset of acute symptoms such as chest pain, discomfort in the left arm, jaw or neck, sweating, nausea or weakness. "Unfortunately," he says, "only a fraction of patients who are eligible for these treatments receive therapy in time; this is due, in large part, to the time delay between the onset of symptoms and arrival at the hospital."

Mann's team randomly telephoned 962 people in 20 communities across the United States and asked, "If you thought someone was having a heart attack, what would you do?" Two optional responses were (1) call 911 or an ambulance, or (2) drive the person to a hospital. On average, 89 percent of the respondents from each community said they would call 911 if they witnessed a person having a heart attack -- the action recommended by the American Heart Association. About 8 percent said they would consider driving someone with possible heart attack symptoms to the hospital.

Researchers also collected information on 875 individuals in the same communities who arrived at the emergency room with chest pain. These individuals were asked how they arrived at the hospital and what factors caused them to go quickly or wait to go to the hospital. Contrary to the intentions expressed by the non-patient community members in the telephone poll, few actual chest pain sufferers used EMS -- only 23 percent. About 60 percent were driven to the emergency room by someone else, while 16 percent drove themselves to the hospital.

Mann says that some people delayed calling EMS or going to the hospital because they took aspirin, or believed their symptoms were due to heartburn and took an antacid. Others, he says, put off calling EMS after speaking to their doctor.

The study indicates that 83 percent of patients who spoke with a physician and were later admitted to the hospital for a heart attack did not use emergency transportation.

"It is problematic that communication with a doctor decreased EMS use," Mann says "Speaking with a doctor may have reduced patient anxiety in a way that made EMS transport seem optional."

Mann says the people most likely to call EMS were those who were older, lived alone, had a history of heart disease, or who lived in a community with free ambulance service due to a tax-based prepayment plan.

The study reports that the presence of a tax-based prepaid EMS system doubled the likelihood of using EMS compared with communities with no such system. Though certain variables may bias this finding, Mann says other studies have documented a similar pattern. He believes programs that offset the cost of EMS transportation should be studied further.

"These programs could represent a major factor among people evaluating options for emergency transportation," Mann says.

According to Rose Marie Robertson, M.D., president of the American Heart Association, the association strongly advocates calling 911 immediately when a cardiac emergency is detected. "Our operation Heartbeat initiative, which is being launched in more than 100 communities, helps provide tools to get the 'call 911' message out to the general public," she says. "This study provides more evidence that the public needs to hear this message."

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Co-authors of the study are Adam L. Brown, B.S.; Mohamud Daya, M.D., M.S.; Robert Goldberg, Ph.D.; Hendrika Meischke, Ph.D.; Judy Taylor, E.D.D.; Kevin Smith, M.A.; Stavroula Osganian, M.D.; and Lawton Cooper, M.D.

NR00-1155 (Circ/Mann)

Media Advisory: Dr. Mann can be reached by phone at 801-585-9161; or by email at clay.mann@hsc.utah.edu. (Please do not publish numbers or email addresses.)

CONTACT: For journal copies only, please call: 214-706-1173
For other information, call: Carole Bullock: 214-706-1279 caroleb@heart.org


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