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Post-Heart Attack Care: The Quicker the Better

Timing of bypass or angioplasty makes a difference

(HealthDay is the new name for HealthScoutNews.)

TUESDAY, Aug. 5, 2003 (HealthDayNews) -- After the first flurry of treatments that keep a heart attack patient alive, the timing of later measures to improve blood flow can be critical, too.

And the faster a patient gets either an artery-opening angioplasty or bypass surgery, the fewer complications he or she will experience, a new Canadian study finds.

"Faster is better," says Dr. David A. Alter, an assistant professor of medicine at the University of Toronto and lead author of an article in the Aug. 6 Journal of the American College of Cardiology. The study examined the experiences of more than 15,000 heart attack survivors.

But the study measured "faster" in days, not hours.

Patients admitted to major medical centers equipped to perform the two revascularization methods that increase blood flow to the heart had one procedure or the other after an average of 12 days. Patients first seen at community hospitals waited an average of 48 days.

"Delays in revascularization in these heart attack patients resulted in significant hazards," Alter says, although there was no difference between the two groups in long-term outcome.

Readmissions to a hospital for a heart problem were less common in the patients who had quicker procedures -- 41.5 "events" per 100 patients, compared to 68.9 events per 100 patients among those who waited longer. And hospital stays were longer for the second group, an average of 5.17 days, compared to 3.79 days for those who were revascularized more quickly.

In terms of big hospital versus little hospital, the Canadian results aren't quite applicable to the United States, Alter says.

"We have a limited number of hospitals that are equipped with facilities for angioplasty," he explains, while community hospitals in the United States are much more likely to have those facilities.

Dr. Harold L. Dauerman, an associate professor of medicine at the University of Vermont College of Medicine who wrote an accompanying editorial, says the study is another piece of evidence to support the view that "quicker is better."

There is a not-quite-settled debate about whether invasive measures such as angioplasty or bypass surgery should be done sooner or later, Dauerman says. "But if the invasive approach is used, this registry study is another strong argument for applying it in the early period after hospitalization for a heart attack," he writes.

Patients can play a role in the decision, Dauerman says. Someone admitted to a community hospital "can request a transfer to a hospital with full services," he notes.

As for the doctor's role, "this manuscript helps give the physician evidence why a patient should be transferred" to a hospital that can handle the sophisticated procedures, Dauerman says. "It is not a mandate, but an advisory role the physician can play."

More information

You can get an overview of these revascularization procedures from the American Heart Association or the National Library of Medicine.

SOURCES: David A. Alter, M.D., Ph.D, assistant professor, medicine, University of Toronto, Ontario; Harold L. Dauerman, M.D., associate professor, medicine, University of Vermont College of Medicine, Burlington; Aug. 6, 2003, Journal of the American College of Cardiology
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