Heart attackSymptoms of myocardial infarction (MI) may have been missed in many patients admitted to hospital, according to a study on all heart attack hospital admissions and deaths in England.

The authors, from Imperial College London, say more research is urgently needed to establish whether it is possible to predict the risk of fatal MI in patients for whom this condition was not recorded as the main reason for hospital admission.

The classic symptoms of heart attack may be subtle or even absent in some cases of MI, which may therefore be missed or overlooked.

In this study, the researchers examined records of all 446,744 NHS hospital stays in England between 2006 and 2010 that recorded MI, as well as the hospitalisation history of all 135,950 MI deaths.

The records included whether or not patients who died of a heart attack had been admitted to hospital in the previous four weeks and if so, whether signs of MI were recorded as the primary diagnosis, secondary diagnosis, or not recorded at all.

One in six (16%) of the patients who died from heart attack had been hospitalised during the previous four weeks, but symptoms of MI were not mentioned on their hospital records.

The authors say there are certain symptoms, such as fainting, shortness of breath and chest pain, that were apparent up to a month before death in some of these patients, but doctors may not have been alert to the possibility that these signalled an upcoming fatal heart attack, possibly because there was no obvious damage to the heart at the time.

These results suggest that possible signs of upcoming fatal heart attack may have been missed, say the authors.

Further research is planned to look into why this pattern emerged, and to try to prevent more cases of fatal MI.

Lead author Dr Perviz Asaria 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.”

For more information visit The Lancet.