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Breathlessness heralds worse survival than chest pain for heart attack patients – warns study

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Only 76 percent of heart attack patients who have shortness of breath also known as dyspnoea or fatigue as their primary symptom survive a year, compared to 94 percent of those who have chest pain, says new study.

New research says that the survival rate for patients with dyspnea or fatigue as their primary symptom is just 76% after a heart attack, compared to a survival rate of 94% for people with chest pain as their primary symptom.

This is the conclusion of a study presented today at the ESC Acute CardioVascular Care 2022 conference.

Dyspnoea and extreme tiredness were more common heart attack symptoms in women, older people and patients with other conditions such as high blood pressure, diabetes, kidney disease and lung disease,” says Dr. Paulo Medeiros, the study author. “While our study did not show that these symptoms cause poorer outcome, they were warning signs of greater risk.”

Read more: When shortness of breath could signal you have heart problems

Although chest pain is the most common symptom of myocardial infarction, other symptoms like shortness of breath, upper abdomen or neck pain, or momentary loss of consciousness (blackouts) may warrant a trip to the emergency room. This study looked into which patients report unusual complaints and whether these symptoms have the same outcomes as chest discomfort.

The research looked at non-ST-elevation myocardial infarction (NSTEMI), a kind of heart attack in which a blood vessel supplying the heart is partially blocked. Data from the Portuguese Registry of Acute Coronary Syndromes was used by the researchers. Between October 2010 and September 2019, 4,726 individuals aged 18 and up were admitted to the hospital with NSTEMI.

The participants in the study were on average 68 years old, with 71 percent of them being men. The patients were separated into three groups based on their primary symptom at the time of presentation. The most prevalent presenting symptom was chest discomfort (4,313 patients; 91 percent), followed by dyspnoea/fatigue (332 patients; 7 percent), and syncope (332 patients; 7 percent). (81 patients; 2 percent ).

Read More: Shortness of breath is more deadly than chest pain for heart patients – study shows

Dyspnoea/fatigue patients were much older than the other two groups, with an average age of 75 years compared to 68 years for chest pain patients and 74 years for syncope patients. Patients with dyspnoea/fatigue were also more likely to be women (42 percent) than those with chest pain (29 percent women) or syncope (37 percent women). Patients with dyspnoea/fatigue as their primary symptom were more likely to have high blood pressure, diabetes, chronic renal disease, and chronic obstructive pulmonary disease(COPD) than the other two groups.

At one year, the researchers compared the survival rates of the three groups. Patients with dyspnoea/fatigue were alive 76 percent of the time a year after a heart attack, compared to 94 percent in the chest pain group and 92 percent in the syncope group. In the year following their heart attack, 76 percent of patients with dyspnoea/fatigue avoided being admitted to the hospital for a cardiovascular reason, compared to 85 percent of patients with chest pain and 83 percent of patients with syncope.

Dr. Medeiros adds: “Patients presenting with shortness of breath or fatigue had a worse prognosis than those with chest pain. They were less likely to be alive one year after their heart attack and also less likely to stay out of hospital for heart problems during that 12-month period.”

After then, the researchers used a multivariate analysis to see if chest discomfort, dyspnoea/fatigue, or syncope were all independent predictors of one-year survival. Age, COPD, atrial fibrillation, left ventricular ejection fraction, severe hemorrhage, and ventricular tachycardia were all taken into account. None of the symptoms were shown to be reliable predictors.

Dr. Medeiros further adds: “Shortness of breath was more common among patients that died during the year after their heart attack. However, when considering all of the studied variables, the type of presenting symptom was not an independent predictor of mortality, meaning that we cannot specifically state that shortness of breath was the reason for the worse outcome. Poorer survival may be due to other factors in those patients, such as reduced heart pump function.”

He concludes: “This study highlights the need to consider a diagnosis of myocardial infarction even when the primary complaint is not chest pain. This may be particularly important for women and older patients where diagnosis could be delayed and result in worse outcomes. In addition to the classic heart attack symptom of chest pain, pressure, or heaviness radiating to one or both arms, the neck or jaw, people should seek urgent medical help if they experience prolonged shortness of breath.”

Image Credit: Getty

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