Friday, June 6, 2008

Despite treatment delays, off-hour heart attack patients don't have increased risk of death
By Kelly Winget

Although previous studies have indicated that patients who are admitted to a hospital after-hours or on weekends for heart attacks have a longer wait for recommended treatment, results have been inconclusive if this meant a greater risk of death. A new study, involving DCRI researchers, found that patients admitted after hours had virtually no increased risk of death compared to patients admitted during regular hours.

The study results were published in the May 13 issue of Circulation.

Researchers analyzed data on more than 62,800 patients who were enrolled in the Get With The Guidelines – Coronary Artery Disease database from the American Heart Association. Patients were admitted to 379 U.S. hospitals between July 2000 and September 2005 for acute myocardial infarction, or when blood flow to the heart is blocked. Patients were separated into patients admitted weekdays from 7 a.m. to 7 p.m. and patients who were admitted during off-hours (weekends, holidays and between 7 p.m. and 7 a.m. weeknights).

Approximately 54 percent of patients arrived during off-hours. Researchers found these patients were somewhat less likely to have angioplasty, or primary coronary intervention (PCI), to widen their arteries. It also took an average of 110 minutes for door-to-balloon time for after-hours patients, compared to an average of 85 minutes door-to-balloon time for patients who were admitted during regular hours.

Despite the delays in starting the recommended treatments for heart attacks and fewer PCIs performed, researchers did not find a measurable difference in the in-hospital mortality rate between patients admitted during regular hours or after-hours, especially in the first 24 to 48 hours.

Heart attacks are a leading cause of death in the U.S., but mortality rates can be lowered by use of proven therapies, such as PCI. Despite efforts to improve timely delivery of these treatments, recent studies have shown there are still gaps in routine clinical care for patients having heart attacks, depending on when they are admitted to a hospital.

In this new comprehensive study on regular versus off-hour heart attack treatment, researchers also found that patients admitted after-hours tended to be younger, were more likely to be minorities and had slightly higher average body mass index. They were also more likely to have had previous heart attacks, or to have heart failure or diabetes. The study also found that patients admitted after-hours were slightly more likely to receive beta-blocker treatment, which help the heart muscle relax and can help improve the heart's ability to pump blood.

Researchers recommend that healthcare providers continue trying to eliminate disparities between regular and after-hours care by focusing on timely delivery of evidence-based treatments for all patients.

DCRI researchers involved in the study were Li Liang, PhD, Kristin Newby, MD, and Eric Peterson, MD.