Fewer heart attacks, but too many don’t call for help in time

Half of those with clear heart attack symptoms decide not to call for a Magen David Adom ambulance because they fear they will have to pay or are unaware of the implications of their symptoms.

File photo: Heart surgeons perform an operation (photo credit: REUTERS)
File photo: Heart surgeons perform an operation
(photo credit: REUTERS)
There has been a 50% drop in severe heart attacks in Israel during the past decade due to improved prevention and lifestyle changes, according to the Health Ministry’s Center for Disease Control and the Israel Heart Society. The data appear in the Acute Coronary Syndrome-Israel (ACSIS) survey that has been conducted biennially since 1992.
But there is also bad news in the report: Half of those with clear heart attack symptoms decide not to call for a Magen David Adom ambulance because they fear they will have to pay or they are unaware that their symptoms mean a myocardial infarction.
The ACSIS survey, scheduled to be unveiled Tuesday at the annual meeting of the Israel Heart Society in Tel Aviv, will show a significant improvement in mortality rates. The conference will be attended by 1,500 senior cardiologists from Israel and abroad.
In the past decade, the number of acute myocardial infarctions (heart attacks) has dropped by half. In addition, the mortality rate from the infarctions has also declined significantly, according to the latest survey of more than 1,900 patients. The survey does not include data from patients who experienced acute and fatal heart attacks and died before reaching the hospital.
One of the most significant reasons for the decline is that 82% of patients in Israel undergo life-saving cardiac catheterization during the first hours after the onset of symptoms – an unprecedented figure compared to other developed countries. This percentage has been constantly rising in the past decade and constitutes a badge of honor and a measure of the quality of Israeli cardiology, the society said.
The mortality rate during hospitalization of acute myocardial infarction patients is only 1.6%; one month after admissions, 3.1%; and one year later 7.6%. These numbers are among the lowest in the world in the last decade and improve with each survey.
The report also included a time difference from onset of symptoms of myocardial infarction to initial medical care. Men go for medical help with a median time of 90 minutes. For women, the median time is 128 minutes. From diagnosis to arrival at the hospital the median is 50 minutes in Israel compared with 60 minutes in Europe.
THIS PERIOD of time from the arrival of the ambulance medics and paramedics is critical to patient survival and directly affects morbidity and mortality. Following effective treatment, only one in five heart attack patients suffers extensive damage to the heart muscle.
The most common places in which primary medical contact is made with patients having a myocardial infarction are: 27% in hospital emergency rooms; 39% in urgent care or health fund clinics; and 29% in MDA ambulances.
Data about female patients were also encouraging: After adjustment for background disease and severity of the disease, no significant difference was observed in mortality in women compared with men at any point in time.
However, a worrisome statistic that has remained constant over the last decade shows that nearly half of the patients (44%) who have a heart attack come to hospital emergency rooms without an ambulance, thus endangering their lives. One of the reasons for this is apparently insufficient awareness of the symptoms of heart attack (chest pain or abdominal pain, shortness of breath, cold sweating, sudden severe weakness and/or nausea), but also because of the concern about the cost of ordering an ambulance.
Asked to comment, cardiologist Prof. Amos Katz, dean of Ben-Gurion University’s Medical Faculty, told The Jerusalem Post he has noticed over many years the reluctance of patients to call for an ambulance – especially in the periphery and among economically weak populations – is because they fear their health fund will not reimburse them for the cost if they are not hospitalized.
Since 1992, information on more than 15,000 patients received with acute myocardial infarction and unstable angina has been collected in 25 cardiac intensive care units throughout the country. The data are processed by the cardiac intensive care department in the Heart Society and with the assistance of the Israel Center for Cardiovascular Research.
Prof. Ran Kornowski, president of the Israel Heart Society and head of the cardiology department at the Rabin Medical Center in Petah Tikva, said: “One of the main reasons for the decline in mortality in Israel is the giving of urgent and life-saving cardiac catheterizations, as well as extensive use of life-saving drugs such as blood thinners and cholesterol reduction during and after an infarction. The improvement in preventive heart medicine, the transition to a healthy lifestyle and exercise and the fight against smoking significantly reduce the risk of heart attack and death.”
Dr. Zaza Iakobishvili, head of the society’s cardiac intensive care department, said data attesting to the high quality of intensive care units and catheterization institutes in Israel. In this sense, Israel serves as a model and a global example in this important medical field, he said.
United Hatzalah, which provides free and speedy medical attention around the country, provided by 4,000 volunteers, has 37 of its own ambulances. If anyone with heart attack symptoms plans to avoid calling an MDA ambulance because he can’t pay for the service if not hospitalized, he can call UH at 1221 and be taken at no charge to the nearest hospital.