Men with chest pain reluctant to dial 911

Who you gonna call?

Not an ambulance, if you're like many guys with chest pain

What do asking for directions and calling 911 have in common?

Men, it seems, don't like to do either. When it comes to a heart attack, reluctance to call 911 could make the difference between life and death.

Gender differences in calling for rescue services emerged in a recent Minnesota study of 1,263 patients who suffered a major heart attack. It found that 37 percent of men from rural communities arrived at a hospital in an ambulance, compared with 49 percent of rural women. The rest of both sexes drove themselves or were chauffeured by a relative or friend.

Whatever your gender, the bigger issue is that only about half of people in the throes of a heart attack decide to call 911, and that can have important consequences not only for survival, but also for the long-term health of your heart if you do survive.

Heart experts and public-health officials have long been stymied in efforts to get people to pick up the phone instead of their car keys when experiencing symptoms such as chest pain, sweating and shortness of breath. Indeed, many people fail to take any immediate action, not wanting to bother anyone in case it's a false alarm.

Now there's fresh reason to act quickly by calling 911. Thanks in part to initiatives of the American College of Cardiology and the American Heart Association, hospitals and communities around the U.S. are scrambling to improve heart-attack care. They're improving coordination with emergency squads and adopting measures to speed door-to-treatment time once a patient arrives at the hospital. The faster the heart-attack causing clot is cleared, the quicker blood supply is restored to heart muscle. That minimizes permanent damage that can lead to chronic heart failure.

But patients may not benefit if they don't start the process with a timely call to 911. Even calling your personal physician first often leads to delay.

One big reason to call for an ambulance is the risk of sudden death. Up to 5 percent of patients go into cardiac arrest en route to the hospital. If you're not revived within two minutes, your odds of survival plummet. "If you go into a lethal arrhythmia while you're driving to the hospital, it's pretty hard to do CPR on you," says Barbara Unger, head of cardiac emergency services at the Minneapolis Heart Institute. An ambulance is typically equipped with gear to spark your heart back into rhythm.

In addition, emergency squads are increasingly able to do an electrocardiogram in the field, enabling a pre-hospital diagnosis that can speed the path to treatment. In Boston, some heart-attack patients are taken from the ambulance directly to the cardiac-catheterization lab for an angioplasty, bypassing a time-consuming workup in the emergency room that would be necessary for patients arriving by car.

Conventional wisdom is that people balk at calling 911 because they're in denial. But embarrassment and loss of control may be more important. Joseph Ornato, chairman of emergency medicine at Virginia Commonwealth University, Richmond, says a Baltimore woman called an ambulance for her first heart attack, but came by car when she had a second a few years later. Her neighbors, drawn by sirens and flashing lights, had come to watch as she was carried from her home on a stretcher, and she vowed she "would never let that happen again," Dr. Ornato says.

Heart attacks are often hard to diagnose, and ambulance services vary in sophistication and training. But the Minnesota study, presented by Minneapolis Heart Institute researchers at a meeting of the Society of Academic Emergency Medicine last May, offers a hint of the advantage in calling 911. Rural patients were treated six minutes sooner if they called 911; patients from urban areas got their arteries opened 18 minutes faster when they called an ambulance. For the record, urban men and women called 911 in equal percentages -- 65 percent.

If you're at heart risk, learn the capabilities of your local emergency squad, suggests Elliott Antman, director of the coronary-care unit at Brigham and Women's Hospital, Boston. And whether you're male or female, ask your doctor for directions on what to do should symptoms arise.