Give cardiac a rest
A campaign coaxing men to dial 999 if they feel a pain in the chest will make more 'worried well', and possibly delay treatment for the really ill.
Last week the British Heart Foundation (BHF) launched their ‘Doubt Kills’ campaign. Posters show a middle-aged man with a belt of pain around his chest, bearing the warning: ‘a chest pain is your body telling you to call 999’. Radio advertisements feature bereaved spouses, describing how their loved ones put off calling for an ambulance when experiencing chest pain.
The BHF explain in their campaign literature that every second counts when dealing with a heart attack, and that one of the reasons for delays in getting treatment is the time taken to get to hospital. This is true, and the aim of proving that heart attacks are a ‘treatable disease’ is laudable. Research funding from the BHF has contributed to recent leaps in understanding of heart disease and its treatment. Mortality from coronary heart disease (the disease underlying heart attacks) in those under 65 has dropped by over 40 per cent in the last 10 years. From this perspective it makes sense to target an area where results from treatment could be improved. Also of course raising awareness of heart disease keeps up the BHF’s steady stream of donations.
But the use of a middle-aged man in the poster campaign is interesting. Certainly men are more likely to die of heart attacks. However, the BHF cites research that suggests it is elderly people, particularly women, and those with pre-existing heart disease, who are most reluctant to call for help. So, why not have a female chest pain sufferer on the posters? Or why not target information at those with known heart disease, who are much more likely to suffer from a heart attack?
‘Doubt Kills’ should be seen in the context of an increasing number of health campaigns targeted specifically at men, and their attitudes to health. The BHF explicitly point out that ‘British reserve and stoicism is costing lives’. This pathologising of the traditional stiff upper lip is characteristic of such campaigns. I suspect a survey of accident and emergency (A&E) doctors would find the opinion that a little more stoicism among the British public might not go amiss.
In a YouGov poll commissioned by the BHF, 64 per cent of respondents stated they would first call their partner, friend, relative, GP or NHS Direct when experiencing chest pain – with 42 per cent preferring to ‘wait and see’ if their chest pain gets better. No information is provided about the age of those polled, but the truth is, for many of us, this is a sensible course of action. After all, heartburn is much more common than a heart attack.
The Ambulance Service are nobly supporting the campaign, but it must have occurred to them that a possible result will be more calls from worried young people with indigestion, and consequentially, longer waits for those who are genuinely ill. As with other ‘worried well’ campaigns in recent years, this latest initiative could make the population at large unnecessarily concerned about their health, while overburdening the health system to the extent that it cannot speedily deal with those who are actually suffering ill-health. It may fill A&E with people who mistakenly believe they are having a heart attack, thus reducing the response time to those who really are having a heart attack.
Liz Frayn qualified as a doctor in Glasgow, and now works in psychiatry in Plymouth.
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