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Andy Jones

When doubt kills

According to the British Heart Foundation someone dies from a myocardial infarction every five minutes in the UK. The BHF is about to start a year-long campaign to highlight the danger of delays in patients with chest pain being evaluated. A cause worth championing indeed.

There has been a rise in defibrillators in train stations and shopping centres. This is because 30 per cent of people who have suffered an MI die before reaching hospital. Ventricular fibrillation is the single greatest factor leading to death – there is no excess adverse outcome if VF is averted promptly.

The biggest predictor of outcome is the time to restore blood flow to ischaemic heart cells. Mortality is twice as high for patients treated in the four to six hours after the onset for symptoms as in patients treated within one to two hours.

No time to lose

Reported figures show our ambulance colleagues are working hard, in many areas offering thrombolysis prior to hospital.

In 2004, 80 per cent of patients received thrombolysis within 30 minutes of hospital arrival. But the median time from symptoms to treatment remains 140 minutes and it seems the main reason is a delay in patients contacting help. Polling suggests 40 per cent of patients are reluctant to dial 999 and some prefer to wait. The delays are greatest in the elderly, women and – strangely – those with known heart conditions and diabetes.

Rapid and appropriate care is of course medical common sense. But, to bang my favoured drum of provision inequalities, reperfusion is either offered in the form of aspirin and thrombolysis or by coronary angioplasty, a factor that seems to depend more on geography than medical need.

So while the BHF is admirably putting patients to rights suggesting that dialling 999 is the safest approach, the medical community needs to consider why there are such geographical differences in the approach to revascularisation and utility differences between various patient groups.

The campaign against delay is obviously a good one. Just remember – doubt kills. Call 999 immediately.

pulse@cmpi.biz

Dr Andy Jones is a GP in Stamford, Lincolnshire – he is also PBC director, UnitedHealth Europe

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