Thousands are dying because doctors 'miss early signs of heart attacks'

Updated: 

A sixth of heart attack deaths in England may be the result of hospital doctors failing to spot potentially life-threatening symptoms, research has shown.

The findings from a major study of almost 136,000 cases of fatal heart attack between 2006 and 2010 indicate that many patients are dying because of missed warning signs.

Symptoms of a heart attack include sudden chest pain or a "crushing" sensation that may spread down either arm.

Patients may also experience nausea or shortness of breath. But some heart attacks have more subtle symptoms that can be overlooked.

Of the fatal heart attack victims studied, 21,677 - almost 16% of the total - had been admitted to hospital up to four weeks before their death, the study showed.

Yet no mention of heart attack symptoms was made in their hospital records.

Symptoms such as fainting, shortness of breath and chest pain would have been evident up to a month before death in some of these patients, said the researchers.

Lead scientist Dr Perviz Asaria, from the School of Public Health at Imperial College London, said: "Doctors are very good at treating heart attacks when they are the main cause of admission, but we don't do very well treating secondary heart attacks or at picking up subtle signs which might point to a heart attack death in the near future.

"Unfortunately, in the four weeks following a hospital stay, nearly as many heart attack deaths occur in people for whom heart attack is not recorded as a primary cause, as occur after an admission for heart attack."

The team examined records of  446,744 NHS hospital stays involving heart attacks between 2006 and 2010, as well as the history of all 135,950 heart attack deaths in England over the four years.

The total number of patients who died included those who had a fatal heart attack in hospital or at home or elsewhere. 

Now the researchers, whose findings appear in The Lancet Public Health journal, are calling for a deeper investigation into why avoidable deaths were occurring.

Co-author Professor Majid Ezzati, also from Imperial's School of Public Health, said: "We cannot yet say why these signs are being missed, which is why more detailed research must be conducted to make recommendations for change.

"This might include updated guidance for healthcare professionals, changes in clinical culture, or allowing doctors more time to examine patients and look at their previous records.

"What we are now asking is, if symptoms are being missed where they could have been discovered using the available information, how should care now be organised and what changes need to be made to prevent unnecessary deaths."

Professor Jeremy Pearson, associate medical director at the British Heart Foundation, said: "This study shows that large numbers of people who die of a heart attack have visited hospital in the month before but have not been diagnosed with heart disease.

"This failure to detect warning signs is concerning and these results should prompt doctors to be more vigilant, reducing the chance that symptoms are missed and ultimately saving more lives."