Insurance Worries Linked to Delays in Getting Heart Attack Care

A lack of insurance has been linked to delays in patients going to the emergency room when suffering a heart attack, according to research released Tuesday.

A collaboration of investigators studied more than 3,700 patients who suffered heart attacks and came to 24 medical centers in the United States for care.

While patients who may be suffering a heart attack are advised to get medical care within two hours, doctors found that even many patients with health insurance coverage did not do so, a problem that was even greater among patients without insurance or patients who may have been underinsured.

"The message, even among those patients who are adequately insured, is that patients do delay coming in to the hospital," said Dr. Paul Chan, a cardiologist at St. Luke's Mid America Heart Institute and one of the study's authors. "No matter what your insurance status is, the onset of chest pains and symptoms for heart attack are not to be minimized."

Almost 49 percent of patients without insurance and 45 percent of underinsured patients had delayed getting care for more than six hours after a heart attack began. Just over 39 percent of insured patients waited more than six hours to get care.

Dr. Clyde Yancy, president of the American Heart Association, said there were a number of lessons to be taken from the study.

"Even amongst those that have adequate insurance ... there really was quite poor adherence to presenting to a facility in a timely manner," he said. But while getting in within a two-hour window may have been critical, "Even for those that had the resources, it didn't happen."

Yancy said the results of the study suggest not simply a problem with health care and coverage, but with reaching out to the community to let them know the symptoms of a heart attack and the importance of seeking care.

"That's the job of everyone, but especially the American Heart Association," he said.

But current health care legislation alone will not be enough to make Americans more likely to seek help, Yancy said.

"It's going to take more than just access to care to make these disparities in access to care go away," he said.

People needed to know more about the signs of a heart attack and more about the risk factors for a heart attack, he said.

"Even when we get over the hurdle of access, we still have a lot more that needs to be done," Yancy said.

Many disparities in heart care could be reduced by teaching patients what can be done to avoid heart problems in the first place, he said.

"We really need to bring the burden of disease down," he said, adding that any system would be taxed if patients became increasingly unhealthy.

"Even in those with health insurance, care is not ideal," Yancy said. "We really have a lot of work to do."

Heart Attack Treatment: Reasons for a Wait

While the current study looked at delays in seeking care for a heart attack, it did less to discern the reasons behind that delay or the ultimate cost in health care dollars of waiting to come in.

Yancy noted that for patients concerned about the affordability of their care because of a lack of adequate or any health insurance, the consequences of waiting to seek care may be worse, as they may end up needing further treatment.

"The very thing that is the impediment to coming to a facility promptly now becomes compounded, because they come there late and need more care," he said.

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