55% Patients Couldn't Understand Seriousness, Died: AIIMS Study On Heart Attacks

Only a small proportion of patients (10 per cent) with cardiac and stroke emergencies reach health facilities within an hour, which is critical in preventing death, a recent Indian study has shown. The sooner such patients reach a hospital, the better the result of their treatment.

The study, conducted by the All India Institute of Medical Sciences (AIIMS) and published in the top medical journal The Lancet, sought to address the reasons for delays at multiple levels in reaching the facilities.

"We conducted a social audit of people who died due to heart attacks or strokes in the Ballabgarh block of Haryana's Faridabad," Anand Krishnan, Professor, Centre for Community Medicine at AIIMS, told NDTV, adding that they wanted to understand if patients reached a hospital in time, what problems they face in accessing urgent care, and what were the reasons for the delay in reaching hospitals.

The study, funded by the Indian Council of Medical Research, was done by three departments of AIIMS -- Cardiology, Neurology, and community medicine.

The study found that around 30 to 40 per cent of people didn't get late because of situations they had control over, Dr Krishnan said, adding that around 55 per cent delayed the hospital visit to understand what had happened -- whether it was a heart attack, stroke, or non-critical pain. They were confused about whether to go to the hospital, he said.

Around 20 to 30 per cent faced issues like a vehicle, or money for treatment, causing the delay. "They wanted to go immediately but faced financial or geographical access issues," Dr Krishnan said.

Approximately 10 per cent of people faced a delay in treatment after reaching the hospital in time, he said, adding that there are issues with emergency response in hospitals. 

The study, which included 435 deaths, was conducted over a year. It started before Covid and ended towards the beginning of the pandemic.

"There may be slight changes, but the figures are expected to be similar across the country," Dr Krishnan said.

Similar studies have been conducted in the past, but they were hospital-based, he said. "This is the first study where we went into the community."

"We shouldn't have beginner's suspicion because this is a very deadly disease. All cases of chest pain, especially on the left side, should be immediately examined by a doctor. Not all chest pain is a heart attack, nether all heart attacks begin with chest pain. There's no full-proof way. We should maintain a high degree of suspicion. People at risk, for example, if they have blood pressure issues, should be extra cautious," Dr Krishnan said, and further advised people to rush to only those hospitals that are fully equipped for immediate treatment.

This descriptive study was conducted in two out of three tehsils (Badkhal and Ballabgarh) of the Faridabad district of Haryana with an estimated population of 21 lakh in 2020-21.

The three-delays model was used to qualitatively classify the delays in care seeking -- deciding to seek care, reaching the appropriate health facility (AHF) and initiating definitive treatment.

"We noted level-1 delay in 38.4 per cent (60 per cent due to non-recognition of seriousness); level-2 delay in 20 per cent (40 per cent due to going to inappropriate facility) and level-3 delay in 10.8 per cent (57 per cent due to lack of affordability)," the study stated.

"Lack of timely care is a predictor of poor outcomes in acute cardiovascular emergencies, including stroke. Delayed presentation leads to delay or failure to provide the most beneficial therapies like thrombolysis for myocardial infarction/ischemic stroke leading to poorer disease outcomes. It is estimated that interventions that reduce delays in care in patients with myocardial infarction (MI) could decrease risk of mortality by 30 per cent," the study said.