Holiday Heart Attacks More Deadly

Hospital understaffing may be the reason, researchers say

MONDAY, March 8, 2004 (HealthDayNews) -- If you go to a hospital with a heart attack during the holiday season, you are more likely to die than at other times of the year, researchers report.

In addition, you are less likely to get lifesaving medications, such as aspirin and drugs called beta blockers, which lower blood pressure. You are also less likely to undergo an angioplasty, which is a procedure to open clogged arteries.

People admitted during the winter holiday weeks were not only less likely to get proper therapy, but also had worse outcomes, says lead researcher Dr. Trip Meine, a cardiologist at Duke University Medical Center.

Meine's team collected data on 134,609 heart attack patients who were listed in the Cooperative Cardiovascular Project, which kept track of patients admitted to U.S. hospitals from 1994 to 1996.

The researcher compared the treatment and outcome of the patients seen during the last two weeks of December and the first two weeks of January to those seen at other times.

They found 77 percent of the patients admitted during the holiday weeks received aspirin compared with 78 percent at other times. There was also a difference in the use of beta blockers, with 43 percent receiving them on hospital admission during the holidays compared with 45 percent during the rest of the year.

Moreover, only 13 percent underwent angioplasty during the holidays compared with 15 percent at other times, according to the report, which was presented March 8 at the American College of Cardiology's annual scientific sessions in New Orleans.

And perhaps worst of all, 23 percent of the patients admitted during the four weeks surrounding Christmas and New Year's died, compared with 21 percent during the rest of the year.

Many studies have shown people are more likely to die from heart attacks during the winter holidays, but none of the studies looked at causes, Meine says.

In their study, the researchers found the number of heart attack patients seen during the four-week holiday period was not different from any other four-week period in the year.

Meine speculates that during these holidays the health-care system is strained, with lower staffing of doctors, nurses and medical technicians.

"This is the reason we saw less angioplasty," Meine says. "And once you see less angioplasty, it is not surprising that mortality goes up."

During periods when staffing is reduced, such as holidays, weekends and nights, patients suffer, Meine says. "We need to do everything we can to minimize or prevent these periods."

"Health care needs to be like a casino: open 24 hours, seven days a week, with no difference in staffing any day or time," Meine says.

Dr. Stephen P. Glasser, a professor of epidemiology at the University of Minnesota, says the finding is not surprising, but he questions that understaffing is the reason for increased mortality.

These problems may or may not be due to reduced staffing, he says. Other studies have shown that heart attacks tend to be more severe during the winter as well as more frequent, which may also account for the finding, Glasser says.

"It could also be factors we know nothing about," he adds. So it may have nothing to do with fewer angioplasties or medications, Glasser says.

"Understaffing as a reason for the findings has merit and makes sense, but whether it's true or not is the question," he adds.

Dr. Robert A. Kloner, a professor of cardiovascular medicine at the University of Southern California, notes that in his own research in Los Angeles, he found deaths from heart attacks are highest during December and January.

Kloner speculates that colder weather, which causes higher blood pressure, is to blame. He also says the increase in heart attack deaths could be due to fewer hours of daylight or holiday stress, overeating and drinking.

"But hospital understaffing may also play a part," he says. "Maybe hospitals need to schedule better and realize that winter holiday time is also the time most heart attacks occur."

More information

The American Heart Association can tell you about heart attacks, while the National Heart, Lung, and Blood Institute has pages devoted to how to survive one.

SOURCES: Trip Meine, M.D., cardiologist, Duke University Medical Center, Durham, N.C.; Stephen P. Glasser, M.D., professor, epidemiology, University of Minnesota, Minneapolis; Robert A. Kloner, M.D., Ph.D., professor, cardiovascular medicine, University of Southern California, Los Angeles; March 8, 2004, presentation, American College of Cardiology annual scientific sessions, New Orleans
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