Broken hearts - routine ECG would help detect undiagnosed heart attacks
A report by Dutch researchers has found that more than two in every five heart attacks go undiagnosed. The study of 7,085 people over the age of 55 in a suburb of the Dutch city of Rotterdam initially looked at chronically disabling diseases. The study on heart attacks was a by-product of this initial research. Some 5148 people from the initial study in 1990 had no evidence of myocardial infarction (MI, or more commonly, heart attack). 4,187 of those people could be adequately followed-up with at least one electrocardiogram (ECG) between 1993 and 1999 to look for undiagnosed heart attacks (141 of the 4,187 had suffered recognised heart attacks). The team followed the study participants for at least six years, on average, and results were calculated by the number of heart attacks occurring in every 1,000 'person years'. 'We found an incidence rate of nine heart attacks per 1,000 person years,' explained Dr Jacqueline Witteman, senior author of the paper. 'There were around 12 heart attacks per 1,000 person years in men (8.4 recognised and 4.2 unrecognised) and around seven per 1,000 person years in women (3.1 recognised and 3.6 unrecognised). Additionally, in men as well as in women, there was one sudden death per 1,000 person years. 'Overall, 43 per cent of the total heart attacks had been clinically unrecognised - a third of the male heart attacks and more than a half of the female heart attacks,' she said. In this 55 to 80 year-old group, men had a greater proportion of recognised heart attacks compared to women, but a similar number of unrecognised heart attacks. Co-author of the research, Dr Eric Boersma believes that the reason why so many more women suffer unrecognised heart attacks could be due to atypical symptoms suffered by many women. 'Men and women experience chest pain in different ways. MIs [heart attacks] can occur without typical symptoms in women (also in people with diabetes and the elderly). They may sense shoulder pain instead of chest pain, they may think they have severe flu that is taking a long time to recover from, and those with an inferior-wall infarction may complain of stomach pain. So women may hold back from reporting symptoms and doctors may also be in doubt whether or not to consider heart disease as a source of the complaints. It is also a problem that women and their doctors have traditionally worried more about death from breast and gynaecological cancer, than from heart disease.' The use of ECG is cheap, non-invasive and easily performed. Routine ECG measurements could be taken to find those people who have suffered unrecognised heart attacks and treat them accordingly. People who have suffered a first heart attack are at an increased risk of developing further heart attacks. If people do not realise they have suffered a first heart attack, then they carry this increased risk. 'People with unrecognised infarctions may also benefit from effective preventive treatment. By that I mean preventive drugs, including aspirin, beta-blockers and statins, and specific lifestyle advice. In most developed countries cardiovascular prevention programmes are installed, which aim to identify high-risk individuals on the basis of classical risk factors, including smoking and obesity, and co- conditions, such as diabetes mellitus. Our findings indicate that these programmes might be enriched with an ECG,' said Dr Boersma.
Countries
Netherlands