Despite worldwide info, Patients with MI or acute coronary syndrome wait too long! 

Every day nearly 700 men and women in Germany suffer from an acute myocardial infarction (MI).

• Up to 50 % will be dead one year later
• Most of them die within the first 24 hours
• 2/ 3 of deaths through MI occur out of hospital

There are annual campaigns not only in Germany but worldwide which explain symptoms, urgent therapeutic interventions and how prognosis and early therapy may improve prognosis after acute MI.
And yet

• People wait too long.
• In the guidelines for diagnosis and treatment of acute MI of the German Society of Cardiology, published in 2000, the authors declare early intervention as the most important strategy to reduce mortality

and yet:

• 20 % of the patients wait more than 12 hours after the onset of symptoms before they call for medical help.
• The mean time interval from the onset of typical symptoms up to the arrival at hospital increased from 166 minutes in 1995 up to 225 minutes in 2003 (GOAL registry).
• Elderly people, women and people suffering from diabetes are those who wait longer than others.
• If the onset of symptoms occurs during night time or during the weekend, or if patients are not able to contact their family doctors, the delay for intervention will be prolonged.
• Information campaigns through the German Heart Foundation, for example, or through local institutions show that, by intensive information, these time intervals can be reduced up to 50 %.
• This beneficial effect diminishes within a short time after the end of these activities.
• Great efforts were undertaken during the last years via television, print media and other groups.

And yet

in 2005 the German Society of Cardiology had to publish that the pre-hospital time interval of people with acute MI had become longer during the last years.

What is to be done?

• Personal instruction of patients through their doctors or nurses seems to be more effective than public campaigns.
• “Repetitio est mater studiorum”, regular training and information courses are necessary.
• Family members have to be involved in these activities.
• Health insurance systems have to develop instruments and goals as well as “Bonus- Malus” structures to educate people at high risk and those having survived the first CV event.
• The “DMP”(Disease Management Program) of the German Government, in cooperation with insurances and Family Doctors as well as with Cardiologists, might be a good tool not only but also to shorten the time interval from the onset of  symptoms to structured and life- saving interventions.

Please let us know if these problems are the same in your country and how they are managed and by whom? (send your response or comments to councils@escardio.org)