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Heart Attacks Keep Their Own Schedules

MANAGED CARE March 2014. © MediMedia USA
News & Commentary

Heart Attacks Keep Their Own Schedules

Patients who suffer a heart attack on weekends and off hours are more likely to die than those stricken during working hours, according to a study in BMJ (formerly the British Medical Journal).

Researchers conducted a metaanalysis of nearly 50 studies done from 2001 to 2013 and including about 2 million patients. Portions of the patient cohort stretch back to 1987.

The authors discuss ST-elevation myocardial infarction (STEMI) and door-to-balloon time—that is, the time between presentation and receiving percutaneous coronary inter­vention. The door-to-balloon time should be 90 minutes or less.

“Patients who presented during off-hours were less likely to receive percutaneous coronary intervention within 90 minutes than were those who presented during regular hours,” states the study (“Off-Hour Presentation and Outcomes in Patients With Acute Myocardial Infarction: Systemic Review and Meta-Analysis”).

The study notes that “higher mortality during off-hours was seen for both in-hospital and 30-day mortality.”

The research was done in the United States, Canada, and Europe. One in 20 in-hospital deaths, or 1 in 29 deaths within 30 days after admission, could be prevented if the higher mortality during off-hours was resolved, the authors contend.

They add that “the 15-minute increase in door-to-balloon time observed during off-hours could increase mortality by as much as 10%–25%, assuming linearity between door-to-balloon time and mortality.”

The difference in outcomes “is likely associated with availability of cardiologists, support staff for the cardiac catheterization laboratory, or both,” the study says.

In addition, 24-hour-a-day cardiology service isn’t available everywhere. Many hospitals have to assemble on-call staff to get cardiac units up and running during off hours.

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