Heart Attacks Less Deadly in Northeast Hospitals

Study finds survival rates highest in that part of the country

MONDAY, May 17, 2004 (HealthDayNews) -- People in the throes of a heart attack or angina are more likely to survive if they are treated in hospitals in the northeastern United States rather than elsewhere in the nation.

That geographical oddity was reported on May 17 at an American Heart Association scientific forum in Washington, D.C. Another report warns of longer waits during the weekend for angioplasty, the "balloon" treatment used in hospitals to open clogged arteries.

In the first study, Dr. Venu Menon, director of the Coronary Care Unit at the University of North Carolina, analyzed more than 56,000 patients treated in 301 hospitals for persistent chest pain, known as unstable angina, or for heart attack. The type of heart attack they studied was called a non-ST elevation myocardial infarction.

Menon's team found the best places for treatment and survival were hospitals in the Northeast, where the death rate was 3.52 percent. In contrast, overall death rates were 4.45 in the West, 4.64 in the Midwest and 3.81 in the South.

What accounts for the differences? "This is still unclear," Menon said. "We adjusted for all clinical, procedural and hospital-related factors that potentially related to outcome."

In an earlier study, he added, the same benefit was found for patients treated in Northeast after a type of heart attack called an ST elevation myocardial infarction.

"This is the first time we are showing a regional difference in outcome with [the non-ST heart attack]," he said.

Menon's group did find the rates of balloon angioplasty and bypass surgery were similar in all four regions but that early use of beta blocker medications to treat heart problems were lower in the South.

Another expert said many variables are at play with heart attacks, so the findings shouldn't be interpreted to mean Northeast hospitals are superior.

"I don't think there's a good explanation for the differences," said Dr. Jesse Currier, co-director of the adult cardiac catheterization lab at the UCLA David Geffen School of Medicine and staff interventional cardiologist at the Santa Monica-UCLA Medical Center.

Patients at raised risk for heart attack shouldn't worry about the study findings, Menon said. "Consumers should not be influenced by this data in any way," he said. "This is a research project that needs further study."

In another report at the same meeting, Dr. David Magid, a Denver emergency physician, reported that weekends involve longer wait times when patients need angioplasty.

"When you come in after hours, you are more likely to have a delay if you have angioplasty," said Magid, assistant director of the Colorado Kaiser Permanente Clinical Research Unit in Denver. His team analyzed data on more than 37,000 patients and found daytime "door-to-balloon" times were nearly 19 minutes longer on weekends than on weekdays. The weekend time averaged 114 minutes, versus nearly 95 minutes on weekdays.

The longest waits were on the midnight to 7 a.m. shift, with an average wait of 117.5 minutes on weekdays and 123 minutes on the weekends.

But Magid also found that patients needing emergency clot-busting therapy such as tissue plasminogen activator (tPA) were all treated within about 34 minutes of admission, regardless of time or day of the week.

While the data can be useful for hospitals hoping to improve treatment, there's also a message for patients, Magid said: "If you have a heart attack, call 911 and let [the emergency personnel] take you to the hospital they deem best for your care."

That's a much better approach, he said, than having a family member drive you to the hospital and perhaps picking one that's close by but not optimally equipped for your specific heart problem.

Most communities maintain an emergency cardiovascular care system that can respond quickly, according to the American Heart Association. Symptoms of a heart attack can include chest discomfort, shortness of breath, sweating, nausea or lightheadedness and other problems.

Cardiology teams are always racing against the clock when treating heart attack patients, Currier said. A procedure such as angioplasty "has to be done with a 90-minute door-to-balloon time," he said, noting that very few hospitals achieve that.

At UCLA, he added, staff who work at the cardiac lab are required to have no longer than a 30-minute response time when they are on call, to cut down on delays.

More information

To learn more about the warning signs of a heart attack, visit the National Heart, Lung, and Blood Institute. To find out about heart attack treatments, visit the American Heart Association.

SOURCES: Venu Menon, M.D. assistant professor, medicine, and director, Coronary Care Unit, University of North Carolina, Chapel Hill; David Magid, M.D., emergency physician, assistant director, Colorado Kaiser Permanente clinical research unit, Denver; Jesse Currier, M.D., interventional cardiologist, co-director, UCLA adult cardiac catheterization laboratory, associate professor, clinical medicine, UCLA David Geffen School of Medicine, and staff interventional cardiologist, Santa Monica-UCLA Medical Center, Santa Monica, Calif.; May 17, 2004, presentation, American Heart Association scientific forum, Washington, D.C.
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