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 Rates of death in the hospital are very low overall, at just over 4
percent, the researchers found. But some life-saving treatments can
take longer to get to patients during off hours, which makes care
less than optimal, they write.
It was actually surprising how similar quality of care seemed to be
for working hours and after hours in the hospital, and even for
balloon angioplasty, there was only a difference of 16 minutes, said
study author Dr. Jorge F. Saucedo of the NorthShore University
Health System in Evanston, Illinois.
In the most severe heart attacks, a blood vessel in the heart is
completely blocked. Using a catheter to thread a balloon into the
blocked artery can immediately restore blood flow.
In the new study, which included more than 50,000 severe heart
attacks between 2007 and 2010 in the U.S., patients who arrived at
the hospital during work hours took an average of 56 minutes to have
angioplasty, the balloon procedure. For those who arrived on nights
or weekends, the average wait time was 72 minutes.
Both times fall within the American Heart Association’s
recommendation of no more than 90 minutes wait for angioplasty. The
time to patients getting imaging or medication was the same for both
groups, according to the results in Circulation: Cardiovascular
Quality and Outcomes.
When the researchers adjusted for a variety of patient
characteristics, they found those who arrived at the hospital during
off hours were about 13 percent more likely to die from any cause.
The proportion of patients who had angioplasty within the
recommended 90 minutes was 89 percent during the weekdays and 79
percent during off hours.
All in all, the numbers are better than in past studies, the authors
note in their report, and in most categories there were no
differences in treatment based on when patients arrived at the
hospital.
Management of these severe heart attacks seems to have improved
greatly over the past several years, said Dr. Rodrigo
Estévez-Loureiro of the interventional cardiology unit at Complejo
Asistencial Universitario de León in Spain.
“Differences observed in (door to balloon) times, although
statistically significant, are not clinically relevant between off
and on-hours,” Estévez-Loureiro, who was not involved in the new
study, told Reuters Health by email.
A 16-minute delay likely will not influence overall mortality from
the heart attacks he said.
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“Also surprising was the very low in- hospital mortality for both
groups,” Saucedo told Reuters Health.
The hospital catheterization laboratory, where angioplasties are
performed, is fully staffed during the day but most hospitals in the
U.S. do not staff the lab after hours, he said. When a heart attack
patient arrives on a night or weekend, staff members are paged and
have to drive to the hospital from their homes.
To make angioplasty wait times equal day and night, catheterization
labs would have to be fully staffed 24-hours per day, but currently
the financial and logistical costs would be too high to recommend
that, Saucedo said by email.
Patients may have waited longer to come to the hospital with heart
attack symptoms in the middle of the night, which might have
contributed to the increased risk of death, he noted. All things
considered, the management and outcomes for people with severe heart
attacks after hours was very good.
One takeaway message for patients, he said, is to come to the
hospital as soon as you have symptoms of a heart attack, including
tightness of the chest, excess sweating, weakness and
light-headedness.
Estévez-Loureiro recommended calling an ambulance to get to the
hospital, since medical personnel may be able to verify if you are
having a heart attack on the way and start administering treatment
and call the catheterization lab en route.
SOURCE: http://bit.ly/XaY6j7
Circulation: Cardiovascular Quality and Outcomes, online July 29,
2014.
[© 2014 Thomson Reuters. All rights
reserved.] Copyright 2014 Reuters. All rights reserved. This material may not be published,
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