NIH News Release
National Heart, Lung, and Blood Institute

Monday, September 10, 2001
11:00 a.m. EDT

For copies of editorial, please call (214) 706-1396
For other information, call:
Communications Office, NHLBI: (301) 496-4236
Tim Elsner, AHA: (214) 706-1340

National 9-1-1 Day: September 11 (9/11)
Citing alarming delays in treatment, NHLBI and American Heart Association
call on physicians to stress need for speed in calling 9-1-1

Washington, Sept. 10 — A joint call to action urging physicians to educate their patients about heart attack warning signs — and the importance of calling 9-1-1 immediately — was announced today at a news conference by the National Heart, Lung, and Blood Institute (NHLBI) and the American Heart Association.

NHLBI Director Claude Lenfant, M.D., and American Heart Association President David Faxon, M.D., note that despite life-saving advances in the treatment of heart attack, only a small percentage of patients are getting to the hospital early enough to reap the benefits of that therapy.

Writing in an editorial titled, "Timing is Everything: Motivating Patients to Call 9-1-1 at the Onset of Acute Myocardial Infarction" published in the September 11 issue of Circulation: Journal of the American Heart Association, Lenfant and Faxon note that delay in seeking medical treatment is a key factor in the nearly one-half million heart attack deaths in the U.S. each year.

The two organizations hope to turn this trend around with the call to action and support of National 9-1-1 Day (Sept. 11), which also serves to launch a major new heart attack education campaign called Act in Time to Heart Attack Signs. National 9-1-1 Day was initiated by the National Emergency Number Association to emphasize the importance of calling for emergency medical help.

Act in Time targets patients and the general public as well as physicians and seeks to raise awareness about the need for a fast response. Key campaign messages encourage recognition of heart attack symptoms, working with a physician to create a heart attack survival plan, and calling 9-1-1 as soon as symptoms begin. Doctor/patient discussions "can deliver a powerful message about key symptoms and appropriate actions to minimize treatment delays," write Lenfant and Faxon.

"Our goal is to save lives by increasing the woefully low number of heart attack patients who are treated within the first hour of experiencing symptoms," says Lenfant. "It is during that crucial 60-minute window that clot-busting medication and other treatments are most effective. Alarmingly, only 1 in 5 patients gets to the hospital emergency department soon enough to benefit from these treatments.

"Most potential heart attack victims wait at least two — and possibly four — hours before seeking medical help and some wait a day or more," Lenfant adds.

One reason people wait before getting help is that they do not realize they are having a heart attack because their symptoms do not match the sudden crushing chest pain depicted in the movies — the so-called "Hollywood heart attack."

"The reality," says Faxon, "is that many heart attacks are much 'quieter,' causing only mild pain or discomfort. In addition to uncertainty about symptoms, many patients fear they will be embarrassed if their symptoms turn out to be a false alarm. And the majority of women still view heart attacks as a 'male' problem even though cardiovascular disease is the leading killer of both men and women."

Campaign materials point out that calling 9-1-1 can increase survival not only by helping patients get to the hospital fast but also because emergency medical personnel can give a variety of medications and treatments even before arrival at the hospital.

Act in Time provides various educational materials for health care providers, heart attack patients and the public. These include a booklet, an educational video, and new Web pages, which can be reached through the NHLBI Web site:

In addition, campaign partners the American Red Cross and the National Council on the Aging will help increase public awareness by offering Act in Time classes through their national networks.

Act in Time materials list the most common heart attack warning signs as pain or discomfort in the center of the chest; discomfort in one or both arms, back, neck, jaw, or stomach; shortness of breath; and other signs, such as breaking out in a cold sweat, nausea, and light-headedness.

The Act in Time campaign is based on the results of REACT (Rapid Early Action for Coronary Treatment), the first large-scale study to evaluate the effects of education on the time it takes people to recognize the warning signs of a heart attack and seek appropriate help. REACT, which was funded by NHLBI and developed under the auspices of the Institute's National Heart Attack Alert Program (NHAAP), showed that relatively few patients call emergency medical services when experiencing chest pain. REACT also found that few people are aware of the benefits of early treatment, in part because they have little communication with their physicians about heart attack symptoms and survival.

Act in Time is one of several cooperative educational efforts being carried out by the NHLBI and the American Heart Association under a broad partnership with other organizations dedicated to helping achieve the objectives of Healthy People 2010, the Federal Government's blueprint for building a healthier nation. Healthy People 2010 objectives include raising awareness of heart attack symptoms, increasing the number of patients treated in the first hour after symptoms begin, and improving access to emergency care.

For additional information on the Act in Time to Heart Attack Signs campaign and related topics, go to the following Web sites:;;; and