New study shows 'slow-onset' heart attack symptoms directly contribute to delay in accessing emergency treatment

November 13, 2013

A major new Irish study carried out by researchers at the School of Nursing and Midwifery, Trinity College Dublin and recently published in the leading international peer reviewed journal, the Journal of Emergency Medicine has revealed that a majority of heart attack sufferers do not experience the classic 'Hollywood' style fast-onset heart attack expected by most patients and that current expectations and perceptions about heart attack symptoms are a major contributing factor in pre-hospital treatment delays in patients experiencing heart attacks.

The study, which was funded by the Health Research Board and which involved almost 900 patients across 5 Irish hospitals, examined the type of experienced by patients who suffered heart attacks and the length of time it took for them to get to hospital.

The researchers found that 65% of patients experienced what is known as slow-onset acute coronary syndrome (ACS) where symptoms were slower, milder and more intermittent while only 35% experienced the more classically perceived fast-onset ACS characterised by sudden intense and severe onset of symptoms such as chest pain, tightness and discomfort.

Whether a patient suffered slow-onset or fast-onset symptoms directly influenced the length of time it took patients to get to an emergency department or treatment by paramedics. Patients who experienced slow-onset ACS took on average of 1.5 hours longer to arrive at the Emergency Department of a hospital than those with fast-onset symptoms. A significant proportion of these patients first phoned (44%) or visited (42%) their local GP whereas patients with fast-onset symptoms were more likely to phone the emergency services. Only a third of those with slow-onset symptoms travelled to hospital by ambulance compared to half of those with fast-onset symptoms.

Delays in treatment of a can have a significant impact on a patient's outcome both in terms of mortality and potential damage to the heart muscle. Patients who are experiencing a heart attack should receive life-saving medical treatment within two hours and ideally within one hour of symptom onset. In addition, advanced paramedics responding to a cardiac situation can begin life or heart saving treatment immediately. The quicker treatment is received the greater the benefits for the patient. The slow-onset heart attack patients in this study, the majority group, had an average of a three and half hour pre-hospital delay compared with a two hour delay for the fast-onset patient cohort. The former delay is considerably outside the recommended and optimum time for treatment.

Commenting on the significance of this research for patients and patient education, lead author Dr Sharon O'Donnell, Director of Undergraduate Teaching & Learning at the School of Nursing and Midwifery, Trinity College Dublin said: "For many years we have tried to reduce pre-hospital treatment delays in patients experiencing heart attacks. Most people expect a heart attack to be associated with sudden, severe and continuous chest pain. However, the most surprising finding for us was that for the majority of people in our study, their heart attack started off with mild or intermittent symptoms such as chest and left arm discomfort, shortness of breath and fatigue."

She continued: "We need to educate people about the fact that most heart attacks start this way, with the 'slow-onset' of heart attack symptoms, which may later intensify. Future educational campaigns must dispel the myth that heart attacks always occur in a dramatic fashion. If someone experiences any worrying symptoms which are unresolved with rest or usual cardiac medication, then they should call an ambulance and go to hospital immediately."

Dr O'Donnell also spoke about the implications of this study for clinicians saying: "Clinicians also need to be aware that most heart attacks have a slow-onset. As well as assessing for the well known 'Hollywood Heart Attack' onset of symptom, clinicians need to be equally vigilant for the milder and slower onset of heart attack symptoms. Most importantly, the finding that 51% of STEMI were slow-onset heart attacks is of particular clinical significance. Patients with STEMI reap the most benefits from early reperfusion therapy and hence it is extremely important that this group of are assessed and treated as quickly as possible."

"This is a very valuable study", said Enda Connolly, Chief Executive of the Health Research Board. "We are delighted to fund quality research which provides new evidence to help guide and inform clinicians, and which helps them to enhance diagnosis, improve clinical care and ultimately lead to better patient outcomes."

Explore further: Study finds Irish people slow to go to hospital with heart attack symptoms

More information: Sharon O'Donnell, Gabrielle McKee, Mary Mooney, Frances O'Brien, Debra K. Moser. "Slow-onset and Fast-onset Symptom Presentations In Acute Coronary Sundrome (ACS): New Perspectives on Prehospital Delay in Patients with ACS." Journal of Emergency Medicine 14 October 2013 DOI: 10.1016/j.jemermed.2013.08.038

Related Stories

Study finds Irish people slow to go to hospital with heart attack symptoms

May 1, 2013
(Medical Xpress)—Patient behaviour is one of the biggest causes of delay in getting to hospital when suffering a heart attack according to the findings of a new HRB-funded study at Trinity College Dublin. The delay is ...

Chest pain duration can signal heart attack

September 11, 2013
Patients with longer-lasting chest pain are more likely having a heart attack than those with pain of a shorter duration, according to a study by researchers at Henry Ford Hospital.

Research gives better understanding of performance urgent health care providers

October 22, 2013
Every year in the Netherlands, thousands of people still die after suffering from a heart attack or stroke, caused by the blocking of one or more blood vessels. With both conditions it is imperative to restore the blood flow ...

In mild strokes, ultra-early treatment may eliminate risk of disability

August 22, 2013
In the case of mild or moderate strokes, getting treatment ultra-fast – within 90 minutes of experiencing symptoms – greatly reduces the risk of suffering disability, according to a new study reported in the American ...

Chest pain prior to a heart attack can protect the heart

February 5, 2013
Patients who experience chest pain in the 24 hours preceding a heart attack, also called preinfarction angina, have smaller heart attacks and improved cardiac function in the contemporary cardiac stenting era, researchers ...

Recommended for you

Could aggressive blood pressure treatments lead to kidney damage?

July 18, 2017
Aggressive combination treatments for high blood pressure that are intended to protect the kidneys may actually be damaging the organs, new research from the University of Virginia School of Medicine suggests.

Quantifying effectiveness of treatment for irregular heartbeat

July 17, 2017
In a small proof-of-concept study, researchers at Johns Hopkins report a complex mathematical method to measure electrical communications within the heart can successfully predict the effectiveness of catheter ablation, the ...

Concerns over side effects of statins stopping stroke survivors taking medication

July 17, 2017
Negative media coverage of the side effects associated with taking statins, and patients' own experiences of taking the drugs, are among the reasons cited by stroke survivors and their carers for stopping taking potentially ...

Study discovers anticoagulant drugs are being prescribed against safety advice

July 17, 2017
A study by researchers at the University of Birmingham has shown that GPs are prescribing anticoagulants to patients with an irregular heartbeat against official safety advice.

Protein may protect against heart attack

July 14, 2017
DDK3 could be used as a new therapy to stop the build-up of fatty material inside the arteries

Heart study finds faulty link between biomarkers and clinical outcomes

July 14, 2017
Surrogate endpoints (biomarkers), which are routinely used in clinical research to test new drugs, should not be trusted as the ultimate measure to approve new health interventions in cardiovascular medicine, according to ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.