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House Calls For Heart Treatment

Fast treatment can mean the difference between surviving a heart attack or not, yet the typical American with chest pain waits two hours before seeking care.

Why? "Because if you call 911, we send the Marines," says a doctor who thinks he's devised a way to get help to people without sirens, flashing lights and a sure trip to the hospital.

The plan: Paramedics arrive quietly, link you to the hospital via video, and do sophisticated tests to see if you're really having a heart attack. If so, they summon an ambulance. If not, they stick a wearable heart-restarter on you — just in case they're wrong — until you see your regular doctor.

Paramedics in Richmond, Va., should start pilot-testing the system within a year, Dr. Joseph Ornato of Virginia Commonwealth University told a meeting of heart experts Friday.

"Is this a wild idea?" he asked. "No. ... It's bringing back the old-fashioned house call" — with the aid of some new, high-tech gadgets.

About 1.1 million Americans will have a heart attack this year. Emergency rooms will get more than 6 million visits from people with chest pain. The trick is telling who's having a heart attack or the angina that is a symptom of heart disease — and who is OK.

Diagnosis isn't perfect. Up to 5 percent of people who go to the hospital with chest pain did have a heart attack but are mistakenly sent home. Conversely, thousands of people undergo hours, even days of hospitalization to learn they're healthy.

Fear of that lengthy, expensive testing contributes to the natural denial — the it-can't-happen-to-me feeling — that makes people delay seeking help, said Dr. James Atkins of the University of Texas Southwestern Medical Center.

Add embarrassment at having ambulances, police, often even firefighters all answer the 911 call, plus the certain loss of control — a trip to the hospital even if you start feeling better — and it's no wonder people hesitate, Ornato said.

Getting to the hospital within 70 minutes of experiencing chest pain can cut chances of dying by 80 percent, Atkins said.

Yet the typical patient waits two hours, guzzling antacids or aspirin and seeking reassurance from relatives that it must be indigestion. Indeed, doctors sigh over the telltale chalky lips on so many patients who seek care only after trying antacids.

Women, the elderly, blacks and the poor delay the longest, as do people with symptoms during the day or while at home.

One study found 89 percent of people said they'd call an ambulance if they witnessed someone having a heart attack, but only 23 percent of those who later had chest pain did so.

Richmond has one of the country's most aggressive heart-attack response systems, Ornato said. Emergency rooms have advanced testing equipment; paramedics respond fast; ambulances cruise streets under direction of a computer program that predicts where the next emergency is most likely to occur.

Still, patients delay calling 911, Ornato laments. So he's devising the experiment:

Paramedics would arrive without sirens or flashing lights, and hook up a NASA-developed, briefcase-sized computer linking the patient to a doctor at the hospital.

They would tape on a full-torso "body map" EKG system, recently approved by the Food and Drug Administration, that provides more heart readings than typical EKGs. It uses weather radar-like colors to light up an area with blocked arteries.

A 15-minute blood test would show certain signals of a heart attack.

In case of misdiagnosis, any patient deemed OK would slip on a wearable defibrillator until they got a full checkup. This vest, FDA-approved last December, straps on under clothing to jump-start a heart, providing extra insurance that Ornato hopes will convince attorneys that his plan is safe to try.

The American Heart Association is helping raise money for the experiment, an "appealing concept," said Dr. Rose Marie Robertson, the AHA's past president.

"All of us are going to look at it with great anticipation," Atkins added.