One in six people who die of a heart attack may have had early warning signs missed

Posted: 27/03/2017

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A new study by Imperial College London has shown that early warning signs of a heart attack may be being missed.

The study looked at the early warning signs of heart failure in individuals who were admitted to hospital but then went on to die of heart failure in the following four weeks.

The research considered 135,950 individuals who had died from heart failure in England between 2006 and 2010 and who had been admitted to hospital in the previous four weeks. The research looked at whether the hospital admission had recorded signs of a heart attack as the primary reason, as a secondary reason or whether the signs of a heart attack had not been recorded at all.

The results of the research were worrying: in 16% of those who had been admitted to hospital in the previous four weeks and who went on to die from heart failure, their hospital records did not mention heart attack symptoms.

Early signs of heart failure such as shortness of breath, chest pain and fainting can be apparent up to a month before a fatal heart attack. Although chest pain can often be severe, some people may only experience minor pain which can be similar to indigestion. Particularly in the case of women, the elderly or people with diabetes, chest pain may not be present at all.

The research highlighted that, since there was no obvious damage to the heart at the time individuals presented at hospitals, the treating doctors may not have been alert to the possibility that these symptoms were a warning sign that a fatal heart attack was approaching.

The lead author of the study, Dr Perviz Asaria, said: “Doctors are very good at treating heart attacks when they are the main cause of admission, but we don’t do very well treating secondary heart attacks or at picking up subtle signs which might point to a heart attack death in the near future.” Professor Majid Ezzati, who also worked on the research, commented: “We cannot yet say why these signs are being missed, which is why more detailed research must be conducted to make recommendations for change. This might include updated guidance for healthcare professionals, changes in clinical culture, or allowing doctors more time to examine patients and look at their previous records.”

In an article published by the BBC News website on the research, symptoms of a heart attack are given as:

• chest pain: a sensation of pressure, tightness or squeezing in the centre of the chest;
• pain in other parts of the body – it can feel as if the pain is travelling from the chest to the arms (usually the left arm is affected, but it can affect both arms), jaw, neck, back and abdomen;
• feeling lightheaded or dizzy;
• sweating;
• shortness of breath;
• feeling sick (nausea) or being sick (vomiting);
• overwhelming sense of anxiety (similar to having a panic attack);
• coughing or wheezing.

Camilla Wonnacott, an associate in the clinical negligence team at Penningtons Manches LLP, commented: “A significant number of the cardiac-related claims we deal with concern individuals who have, sometimes on several occasions, presented to the A&E Department at their local hospital (and to their GP) with symptoms which clearly signal that they have a heart condition, only for these symptoms to be overlooked. Sadly, the result can be that the individual concerned goes on to have a fatal heart attack. We are then instructed by their surviving spouse, often on behalf of dependent children, to bring a clinical negligence claim. This useful research highlights that doctors need to become better at detecting the warnings signs of a heart attack so that appropriate treatment can be given which will, hopefully, save lives.”

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