According to an English study, 16% of the victims had been hospitalized in the previous month for atypical symptoms.
In England, one in six fatal myocardial infarction patients were hospitalized in the month before the diagnosis of infarction was reported by doctors. Could the fatal accident have been avoided? This is the question raised by the study conducted by Professor Perviz Asaria and his colleagues at Imperial College in London, together with researchers from Harvard, USA. The results were published in The Lancet Public Health. The researchers studied the medical record of the 135950 people aged 35 and over who died of a myocardial infarction in England between 2006 and 2010. They found that half had already been hospitalized in the four weeks before the accident Fatal, or a group of 66490 patients.
Missed opportunities or classification errors
They then dismissed two-thirds of those diagnosed with myocardial infarction, either directly or secondarily, and concentrated on the 21677 patients who were not thought of. For the most part (59%), the reasons for hospitalization did not particularly favor a cardiac problem (pneumonia, cancer, infection, fracture of the femur neck, etc.). But for 7566 patients (35%), the diagnosis made during the hospitalization was that of another cardiac disorder, including heart failure or rhythm disorder (atrial fibrillation in particular). In 1368 patients (6%), there were also symptoms suggestive of myocardial infarction, such as shortness of breath or atypical chest pain.
The fact that symptoms are underestimated does not mean that it is a automatically a medical error, but the study shows that the medical profession needs to improve risk stratification to better detect who is at risk of dying from an infarction in the event of atypical symptoms.
Establishing a prognosis is always more difficult than making a diagnosis a posteriori, and there is no question of keeping in the hospital all the people complaining of a gastric embarrassment
As for the chest pain typical of the infarction, a study conducted in North Carolina between 1994 and 2006 showed that it was absent in two thirds of infarcts. Doctors are very good at treating heart attacks when they are the primary cause of admission to the hospital, but much less when they are comorbid (pathology associated with another diagnosis, or when it comes to identifying subtle symptoms that could lead to the imminence of a myocardial infarction.
Failure in detection
These results should encourage physicians to be more vigilant, reduce the risk of missing these symptoms and ultimately save lives.
In France, it is estimated that 120000 infarcts (or acute coronary syndrome) occur each year. Improvements in the management of patients with chest pain have significantly reduced myocardial infarction mortality. But margins of progress still exist, as one-third of patients lose time by visiting their family doctor or by going to their own emergencies instead of directly calling the 112 or 15 emergency service, when they experience typical symptoms infarction (ongoing chest pain).
