Most deaths from heart attacks occur in the first few hours after the onset of symptoms, so quick treatment is essential to save the patient’s life. But all too often, patients wait for hours before seeking medical attention, and grave consequences can result.

A new study reveals a sense of loss of control when symptoms arise could be the reason people experiencing heart attack symptoms don’t seek help promptly, according to the research published in the European Journal of Cardiovascular Nursing.

The research examined 326 individuals receiving treatment for their first or second heart attack who completed a questionnaire. Participants, who were all from Sweden, waited an average of three hours before seeking medical help, and some delayed getting treatment for more than 24 hours. This is the first study to analyze patients’ reactions while waiting for help.

A “perceived inability to act” is why patients who didn’t seek medical help for at least 12 hours failed to contact someone sooner, the survey found. Patients responded with statements such as “I lost all power to act when my symptoms began,” “I did not know what to do when I got my symptoms,” and “I felt I had lost control of myself when I got my symptoms.” Those patients who waited to get medical help for more than 12 hours reported that it took a long time to understand their symptoms and thought they were not grave enough to seek medical care.

On the other hand, the patients who got medical help quickly after correctly identifying their heart attack symptoms said they knew that their symptoms were serious and where they should go for help.

“Acute myocardial infarction (AMI) patients with a prolonged delay were, besides a low perceived symptom severity and urgency to seek medical care, characterized by a perceived loss of control and ability to act,” the authors wrote. “Therefore, future interventions aimed at decreasing delay should pay attention to appraisal processes, and perceived inability to act may be a sign of a health threat and therefore a signal to seek medical care.”

When educating patients about the symptoms of a heart attack and the best way to respond, clinicians should discuss a feeling of powerlessness, study co-author Dr. Carolin Nymark of Karolinska University Hospital in Stockholm, Sweden, said in a statement.

“At the moment, we don’t know why some patients react this way. It is possibly linked to fear or anxiety. This should be a novel element in educating people about what to do when they have heart attack symptoms,” she explained. “For those who delay, every minute counts.”

For patients themselves, Nymark stresses, “If you are having symptoms of a possible acute myocardial infarction, don’t ignore them; please seek medical care. It’s better to be wrong than dead. Even a small reduction in delay could greatly save heart muscle and patients’ lives.”