Nights, Weekends Worst for Heart Attack Help

Patients wait longer for artery-opening procedures at hospitals, study finds

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By Ed Edelson
HealthDay Reporter

TUESDAY, Aug. 16, 2005 (HealthDay News) -- The time of day or day of the week that people arrive a hospital with a heart attack can affect their survival, a new study finds.

The study of more than 100,000 people treated for heart attacks between 1999 and 2002 found that those who arrived on a Saturday or Sunday, or after 5 p.m. on a weekday, had to wait an extra 21 minutes to undergo angioplasty or other artery-opening procedures.

Those extra minutes meant those patients were at a significantly greater risk of dying in the hospital than patients arriving at other times, researchers report in the Aug. 17 issue of the Journal of the American Medical Association.

There was no appreciable difference in the time needed to administer clot-dissolving drugs, the report said.

The real difference is that artery-opening procedures must be done by specialized personnel in what is called a catheterization laboratory -- and they usually work ordinary business hours, said lead researcher Dr. David J. Magid, director of the Colorado Permanente Clinical Research Unit in Denver.

"During regular business hours, interventional cardiologists and other members of the team are in the hospital, so we take patients right into the lab," Magid said. "Whereas during off hours, 5 to 7 p.m. weekdays and on weekends, we have to call the staff in from the outside."

One way to have angioplasty done faster would be to have round-the-clock staffing of the catheterization laboratory, but the clinical benefits "must be weighed against the extra cost of such coverage," the report said.

Another possible solution would be to train ordinary staff to help give angioplasty, but "the benefits of cross-training staff may not be realized unless rapid access to interventional cardiologists is also available," the researchers added.

The solution favored by Magid mirrors that used for victims of serious injury. Metropolitan areas now designate specific hospitals as trauma centers, he pointed out.

"We have 15 or 20 hospitals here in the Denver area, and we have three designated trauma centers," Magid said. "The same is not true in cardiology. We don't have a system where we designate hospitals as major heart centers. That is one possible solution."

Several studies have shown that people who have heart attacks do better if they are taken to a hospital with specialized facilities, even if the trip takes longer than getting to the nearest emergency room. But the study also found that delays in providing angioplasty during off-hours are common to all hospitals, including those that concentrate on the procedure.

Something is being done to help reduce delays in the Denver area, at least, Magid said.

"We have developed a system where we can identify patients in the field," he said. "We see them in the ambulance, and when it seems they can benefit from angioplasty, we call ahead to facilitate the process. That lets us get started earlier. If we have that 10 or 15 minutes early notification, it helps in the hospital."

More information

To learn about the signs and symptoms of heart attack, head to the American Heart Association.

SOURCES: David J. Magid, M.D., director, Colorado Permanente Clinical Research Unit; Aug. 17, 2005, Journal of the American Medical Association

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