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Quicker Treatment for Heart Attack Victims

by Debra Gibson

How do you know if you are having a heart attack? Do you know what to do when you are having symptoms?

Many people don't know and even those who do often delay seeking treatment, wasting valuable time that could save heart muscle or perhaps their life, according to Debra K. Moser, professor and Linda C. Gill chair of Cardiovascular Nursing in the College of Nursing.

Photo of Debra MoserDebra Moser says that if heart attack victims seek immediate treatment, the severity of the attack can be reduced, preventing irreversible damage.

Moser says that each year about one million Americans have an acute myocardial infarction, commonly known as a heart attack. Up to 45 percent of these people will die, 60 percent of them before they ever get to a hospital. But if they sought immediate treatment for their symptoms and received either thrombolytic therapy (also known as "clot-busting"), which uses an intravenous drug to dissolve the clot in the coronary artery that is stopping blood flow to the heart, or other therapies (including angioplasty or coronary artery bypass), the severity of the heart attack could be reduced, preventing irreversible damage and dysfunction.

Time is the enemy for someone who has had a heart attack. "The best outcomes are seen in patients who receive treatment within one to two hours of symptom onset," says Moser. "The problem is, most people wait between two to four hours before seeking treatment." In fact, only five percent of eligible patients receive thrombolytics within an hour and less than 25 percent receive any thrombolytic therapy at all. One-fourth to one-half of patients delay four hours before seeking treatment.

"When people experience pain, they typically try to think it away or wish it away," says Moser. "They try to relax or change positions. Some just pretend nothing is wrong, and others attribute it to more benign causes. Some try home remedies or take a Tylenol. When they do decide to seek treatment, many will drive themselves to the hospital."

Public information campaigns, including television commercials and print advertising, have had little impact on this problem, so Moser is hoping that their new program involving education and counseling intervention delivered by nurses will reduce the amount of time between the onset of symptoms and treatment, ideally reducing it to under an hour.

In this program, nurses are following high-risk patients—typically those diagnosed with coronary artery disease, peripheral arterial disease, or clinical atherosclerotic disease—for 18 months. An advanced practice nurse meets with the patient in his or her home within a couple days after leaving the hospital. (This is the time when patients are most anxious and most likely to have problems following their physician's orders.) Nurses continue to monitor the patient with telephone calls and with further home visits if needed.

While there is certain information all patients receive, the meetings are individualized to meet each patient's needs. On average, patients have an hour of in-person intensive instruction followed by short phone calls, including discussions about typical symptoms, sessions in problem solving, and information on the potential benefits of acting quickly.

"By meeting individually with patients, we can respond to their concerns and questions," says Moser. "It is far more interactive and allows us to reinforce the information they receive in the hospital."

The goal for the study is twofold, Moser says. Through this clinical trial, she hopes to decrease the delay time for patients seeking treatment and to increase use of emergency medical systems such as ambulances.

"The biggest part of the delay in getting appropriate treatment is not waiting for an ambulance or waiting to be treated once at the hospital," Moser notes. "The most devastating delay comes from the patient not making a quick decision to seek treatment. If we can reduce this decision time, we can improve outcomes."

The UK program is part of a $2.8 million National Institutes of Health five-year study to test the effectiveness of health-administered education at five sites around the world.

UK's Reducing Treatment Delay for Heart Attack Symptoms program is accepting patients into the trial. If you have been diagnosed with heart disease and would like to participate, call toll free 866-570-8528. There is no cost to participate in the study.

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