Survival could be improved by better public awareness of symptoms

General practice pp 1060, 1065

Twenty five years after the original epidemiological studies 1 2 two thirds of all patients with coronary artery disease still die before reaching hospital (p 1065).3 These patients have no opportunity to benefit from the advances in hospital treatment of acute myocardial infarction, such as thrombolysis, that have dramatically reduced mortality in hospital. It is particularly sobering to see in the study by Norris et al that among patients aged under 55 who die from cardiac arrest, 91% do so outside hospital, whereas the hospital mortality from acute myocardial infarction in this age group is only 3%.3 The hospital mortality for older patients is proportionally higher, but two thirds of these patients also die before reaching hospital. Is it possible to save more of these patients who die outside hospital?

Several studies, including that by Norris et al,3 show that half these patients who die outside hospital have an unwitnessed cardiac arrest and are therefore not amenable to resuscitation. Nevertheless, half the patients in Norris et …