Patients only recieve rehab if they survive their MI!
Dear Editor
Ischaemic artery disease (IHD) remains the number one killer in the
United Kingdom. Great efforts are in place aimed and reducing risk factors
for IHD: smoking, hypertension, hypercholesterolaemia and so on. Agreed
cardiac rehab is essential but morbidity and mortality would surely be
reduced if we treated myocardial infarction (MI) patients at the earliest
opportunity. National Service Framework (NSF) guidelines aim to reduce
thrombolysis times to 20 minutes in 75% of eligible patients. Efficacy of
thrombolysis falls the longer the delay between onset of chest pain and
treatment. Hospitals have been targeted to reduce “door to needle” times
yet there does not appear to be a huge effort to educate people to seek
advice early with chest pain.
I looked at the case notes of all patients seen in the local hospital
in a month with a complaint of “chest pain” (using the Accident and
Emergency computerized database). Information on delay between onset of
chest pain and coming to hospital and past history of IHD were taken from
the casualty notes. The patient group was looked at as a whole and also
divided into those who had a positive past history of IHD and those that
did not. The time delay between these two groups was compared.
145 patients attended the Accident and Emergency department with a
complaint of chest pain over the sample period. 68 of these patients were
admitted. 33 of those admitted had a previous history of IHD. The mean
delay between onset of chest pain and coming to hospital was 9.8 hours.
The mean delay in those who has a past history of IHD was 11.4 hours. One
patient who had a previous MI in the past waited 4 days before coming to
hospital with chest pain caused by another MI. In those who had no IHD in
the past, the mean delay was 7.6 hours. There was no statistical
difference between these two groups.
Myocardial infarction can present with a spectrum of guises including
chest pain, which can be mild to severe. It can be asymptomatic or
present with arrhythmia or sudden death. All patients that were reviewed
could potentially have had a coronary syndrome.
It has been demonstrated that patients may be waiting too long to
come to hospital and therefore run the risk of not benefiting from
potential treatment. This appears to be the rate-limiting step in pain to
treatment times. We must emphasize, particularly to those who are at risk
of a coronary event, that they should not delay coming to hospital with
chest pain. Patient education appears to be as important, of not more so
than door to treatment times in treating people with potential MI. If we
are to do this, however, hospitals must be able to receive a greater
number of chest pain patients.
Rapid Response:
Patients only recieve rehab if they survive their MI!
Dear Editor
Ischaemic artery disease (IHD) remains the number one killer in the
United Kingdom. Great efforts are in place aimed and reducing risk factors
for IHD: smoking, hypertension, hypercholesterolaemia and so on. Agreed
cardiac rehab is essential but morbidity and mortality would surely be
reduced if we treated myocardial infarction (MI) patients at the earliest
opportunity. National Service Framework (NSF) guidelines aim to reduce
thrombolysis times to 20 minutes in 75% of eligible patients. Efficacy of
thrombolysis falls the longer the delay between onset of chest pain and
treatment. Hospitals have been targeted to reduce “door to needle” times
yet there does not appear to be a huge effort to educate people to seek
advice early with chest pain.
I looked at the case notes of all patients seen in the local hospital
in a month with a complaint of “chest pain” (using the Accident and
Emergency computerized database). Information on delay between onset of
chest pain and coming to hospital and past history of IHD were taken from
the casualty notes. The patient group was looked at as a whole and also
divided into those who had a positive past history of IHD and those that
did not. The time delay between these two groups was compared.
145 patients attended the Accident and Emergency department with a
complaint of chest pain over the sample period. 68 of these patients were
admitted. 33 of those admitted had a previous history of IHD. The mean
delay between onset of chest pain and coming to hospital was 9.8 hours.
The mean delay in those who has a past history of IHD was 11.4 hours. One
patient who had a previous MI in the past waited 4 days before coming to
hospital with chest pain caused by another MI. In those who had no IHD in
the past, the mean delay was 7.6 hours. There was no statistical
difference between these two groups.
Myocardial infarction can present with a spectrum of guises including
chest pain, which can be mild to severe. It can be asymptomatic or
present with arrhythmia or sudden death. All patients that were reviewed
could potentially have had a coronary syndrome.
It has been demonstrated that patients may be waiting too long to
come to hospital and therefore run the risk of not benefiting from
potential treatment. This appears to be the rate-limiting step in pain to
treatment times. We must emphasize, particularly to those who are at risk
of a coronary event, that they should not delay coming to hospital with
chest pain. Patient education appears to be as important, of not more so
than door to treatment times in treating people with potential MI. If we
are to do this, however, hospitals must be able to receive a greater
number of chest pain patients.
Competing interests:
None declared
Competing interests: No competing interests