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    Tuesday, August 10, 2004

    Silent Killers: Sometimes, diseases can be dodgey. And not surprisingly, when the present in an atypical fashion, they sometimes get overlooked. So this story that some heart attacks occur without chest pain holds few surprises:

    In the study, published in the journal Chest, researchers looked at data collected in 14 countries on 20,881 patients hospitalized for acute coronary syndromes. Of those, 1,763, or 8 percent, did not report chest pain. Older patients, women and diabetics were more likely to fall into this group.

    The researchers found that the conditions of about a quarter of such patients were initially misdiagnosed, compared with only 2 percent of patients with chest pain.

    Nothing new or surprising there. In the elderly and diabetics, doctors have to remain ever on guard for the unusual in those groups. However, the next statement gives one pause:

    But in the study, the patients without chest pain were less likely to be given drugs to thin their blood to reduce the risk of further damage, or to undergo surgical intervention. The difference in treatment continued up until the patients left the hospital, when they were less likely to be discharged with prescriptions for drugs to reduce blood pressure or cholesterol.

    The study also found a significant difference in death rates during hospitalization: 13 percent for patients without chest pain versus 4 percent for those with chest pain.

    The authors said that at least some of the difference in survival rates could be explained by differences in health before the heart attacks, and that some might be caused by the delay in diagnosis. But the study also noted that omissions in therapy were not adequately corrected during hospital admission and presumably contributed to the poorer outcome.

    One reason for the differences in mortality could be that the atypical presentations occurred in groups that are less resilient to disease to begin with - the elderly and diabetics. And the differences in medication choices? Could be due to the higher likelihood of intolerance and contraindications to those medications in the elderly and diabetics.

    posted by Sydney on 8/10/2004 08:33:00 PM 1 comments


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    By Blogger tvykTJHr, at 8:06 PM  

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