How to Survive Your Hospitalization: Arrive Early

Symptom-to-door delay among patients with ST-segment elevation myocardial infarction in Singapore.

Waiting longer from symptom onset to arrival at the emergency department for people with an acute myocardial infarction is associated with higher morbidity and mortality. Emerg Med Australas. 2016 Oct 11

Comment: This research found that the factors associated with a longer symptom-to-ER time included: 
  • older age
  • diabetes mellitus
  • presenting symptoms of back and epigastric pain
  •  Malay ethnicity
 There are important implications of this research. First of all, it may likely be that older people and those with diabetes have less intense pain, and thus do not call emergency services right away. Therefore, these groups of people need to be more aware of the signs and symptoms of a heart attack, and have a low threshold for calling emergency services. Back and epigastric pain are not the "typical" symptoms of a heart attack, so having the general public more aware of this possibility, and making individual patients at high risk aware of the relationship between back pain, epigastric pain, and acute myocardial infarction may help. Certain cultures and ethnicities may also be less inclined to activate emergency services; this barrier may be overcome at least in part through improved community education about the benefits of rapid treatment in acute myocardial infarction.

The take-home message: if you have symptoms of a heart attack, activate emergency services promptly, and you will be more likely to survive and less likely to have complications in the hospital.