Early warning signs may have been missed in up to one in six people who died of a heart attack in English hospitals, a study suggests.
All heart attack admissions and deaths between 2006 and 2010 were analysed.
Imperial College London researchers found 16% of those who died had been admitted to hospital in the previous 28 days. Some had warning signs like chest pain.
The British Heart Foundation has called the research "concerning".
The study authors from the School of Public Health at Imperial College say more research is "urgently needed". Alison Fillingham, 49, was at work when she felt a deep ache in her neck and collarbone. She continued her rounds as a homecare nurse before phoning a colleague to ask for advice when the pain didn't go away.
An ambulance was called and a panic attack was diagnosed. But blood tests later in hospital showed that Alison had had a heart attack.
"I've been a nurse for 24 years but I didn't think it was anything to do with my heart. My symptoms were not typical. You expect central chest pain. You think of people clutching their chest but it wasn't like that at all."
And she says there was no urgency about the care she received from paramedics. "If my heart attack hadn't been picked up in hospital, the artery would have blocked completely and I wouldn't be here now."
Last year, Alison, from Lancashire, had coronary artery bypass surgery and is now feeling "fabulous" after taking a few months off before returning to work.
She says: "I was a healthy, active person. I was swimming, hiking and doing yoga three times a week - and now I'm running about again." The research, published in the Lancet, looked at the hospital records of all 135,950 deaths in England due to heart attacks over the four-year period.
The records showed whether the person had been admitted to hospital in the previous four weeks and whether signs of a heart attack were recorded as the primary reason for the hospital admission, a secondary reason or not recorded at all.
The data showed 21,677 of the patients had no mention of heart attack symptoms in their hospital records.
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."
Heart attack symptoms
Chest pain - a sensation of pressure, tightness or squeezing in the centre of the chest
Pain in other parts of the body - it can feel as if the pain is travelling from the chest to the arms (usually the left arm is affected, but it can affect both arms), jaw, neck, back and abdomen
Feeling lightheaded or dizzy
Shortness of breath
Feeling sick (nausea) or being sick (vomiting)
Overwhelming sense of anxiety (similar to having a panic attack)
Coughing or wheezing
Although the chest pain is often severe, some people may only experience minor pain, similar to indigestion. In some cases, there may not be any chest pain at all, especially in women, elderly people and people with diabetes.
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