THE PHYSICIANS ROLE IN MINIMIZING PREHOSPITAL DELAY IN PATIENTS AT HIGH-RISK FOR ACUTE MYOCARDIAL-INFARCTION - RECOMMENDATIONS FROM THE NATIONAL HEART-ATTACK ALERT PROGRAM

Physicians and other health care professionals play an important role in reducing the delay to treatment in patients who have an evolving ac ute myocardial infarction. A multidisciplinary working group has been convened by the National Heart Attack Alert Program (which is coordina ted by the National Heart, Lung, and Blood Institute of the National I nstitutes of Health) to address this concern. The working group's reco mmendations target specific groups of patients: those who are known to have coronary heart disease, atherosclerotic disease of the aorta or peripheral arteries, or cerebrovascular disease. The risk for acute my ocardial infarction or death in such patients is five to seven times g reater than that in the general population. The working group recommen ds that these high-risk patients be clearly informed about symptoms th at they mig ht have during a coronary occlusion, steps that they shoul d take, the importance of contacting emergency medical services, the n eed to report to an appropriate facility quickly, treatment options th at are available if they present early, and rewards of early treatment in terms of improved quality of life. These instructions should be re viewed frequently and reinforced with appropriate written material, an d patients should be encouraged to have a plan and to rehearse it peri odically. Because of the important role of the bystander in increasing or decreasing delay to treatment, family members and significant othe rs should be included in all instruction. Finally, physicians' offices and clinics should devise systems to quickly assess patients who tele phone or present with symptoms of a possible acute myocardial infarcti on.