Health Story

03 December 2008 01:40 BST

Mixed messages 'putting heart patients at risk'

Not knowing when to call 999 about a possible heart attack is putting people's lives at risk, doctors have said.

Writing in the BMJ journal today, Dr Ali Khavandi from North Bristol NHS Teaching Trust and colleagues say that the variety of different messages about what is and is not a heart attack means high-risk heart patients may not contact emergency services soon enough.

Citing statistics suggesting that at least 70 per cent of people who die from heart attacks have previous related problems, the specialists highlight that such patients need to be considered as high-risk.

But many such patients delay, sometimes fatally, before ringing 999 about a suspected heart attack, Dr Khavandi and his colleagues write.

According to the editorial, 40 per cent of people do not immediately call emergency services when suffering a suspected heart attack.

The researchers acknowledge the difficulty in determining between symptoms of angina and those signalling a heart attack, but say that more should be done to help patients make this distinction.

"Ideally, patients would be able to distinguish stable angina from a potentially life threatening acute coro¬nary syndrome, but in reality they do not," they write.

"Therefore the decision about when to call an ambulance needs to balance between an overly cautious strategy that could overburden emergency medical services and one where delayed action leads to higher morbidity and mortality. The balance is difficult to find because international guidance indicates that consensus has not been reached, even among cardiologists."

The researchers highlight different levels of advice, including the British Heart Foundation's (BHF) advice for patients with ischaemic heart disease (IHD) to call an ambulance if chest pains last longer than 15 minutes.

The BHF also recommends using drugs (sublingual nitrate GTN sprays) prescribed to relieve the condition three times during that period.

But the American College of Cardiology recommends one spray and five minutes before calling an ambulance.

Responding to the editorial, the BHF's director of prevention and care, Dr Mike Knapton, acknowledges that "advice can be confusing for people who know they have heart disease".

"Heart patients are prone to getting chest pain frequently - angina - and need clear guidance on how to distinguish angina pain from the symptoms of a heart attack," he said.

"This is crucial as we know that heart disease patients tend to delay a long time before calling for an ambulance when they have a heart attack."