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Wee Hours Deadliest for Heart Attacks in Hospital

Survival lowest during overnight hours, study shows.

TUESDAY, Nov. 11, 2003 (HealthDayNews) -- Hospitalized patients who suffer a heart attack late at night are less likely to survive it than are those who have the attack during the day or evening, new research finds.

"Survival was lower during the night shift," says study author Dr. Mary Ann Peberdy, an assistant professor of internal medicine and emergency medicine at Virginia Commonwealth University Health System in Richmond. She presented her findings Nov. 11 at the American Heart Association's annual conference in Orlando, Fla.

Peberdy's team evaluated records from 250 hospitals participating in the National Registry of Cardiopulmonary Resuscitation. They evaluated almost 18,000 heart attacks that occurred in adults hospitalized between January 2000 and June 2002. The average age of the patients was nearly 68.

After categorizing the attacks by the shift during which they occurred, Peberdy's team found there were no significant differences in the number of heart attacks by shift. But when they looked at survival, both immediate survival and survival from time of the attack to hospital discharge, they found distinct differences.

Day shift was considered from 7 a.m. to 3 p.m., evening from 3 p.m. to 11 p.m., and night from 11 p.m. to 7 a.m.

Initial survival was defined as the first 20 minutes after the attack, Peberdy says. Forty-one percent of those who had their heart attack overnight survived initially, compared to 48 percent of those who had one during the evening and 49 percent of those who had it during the day.

Then they looked at survival to the time of discharge. Eighteen percent of those who had their attacks either during the day or evening shifts survived to discharge, but only 13 percent of those who had the attack on the night shift did.

"Hospitals need to look at this, individually," Peberdy says. "Perhaps there are issues such as staffing [that play a role]. Hospitals need to look at the experience of their night staff on resuscitation."

During the night shift, she adds, staffing tends to be lower. And in her study, she found a patient's heart attack was also less likely to be caught early or noticed on the monitor, which could be another factor in why the survival rate was lower during that time.

"This is something physicians in the medical community have known for a while," says Dr. Ravi Dave, an assistant professor of medicine at Santa Monica-UCLA Medical Center. "Staffing is lower at night, and these events tend to be quiet and sudden in onset."

With less staff around, Dave says, a monitor may get less observation during the night shift, resulting in later detection of the attacks.

While correcting the problem primarily hinges on hospitals re-evaluating staffing, Dave suggests some strategies for hospitalized patients. "I would want to be close to the nurses' station," he says, because help would be close by. The downside of that, he adds, is that your room will be noisier due to the activity at the nurses' station.

"I would want a roommate to help look after you," he adds.

Lastly, he adds, hospitalized patients should follow a no-cell phone rule and ask their visitors to do the same. The devices "can interfere with the monitors and cause static," Dave says.

In another study presented Nov. 11 at the heart conference, Duke University and Wake Forest University researchers found that almost two of three patients arriving at U.S. emergency rooms with heart attack symptoms do not receive clot-inhibiting drugs during the first 24 hours of symptom onset, despite studies that prove these drugs save lives.

The drugs are termed glycoprotein (GP) IIb/IIIa inhibitors and work by blocking receptors on blood platelets so they can't form clots. The researchers urged emergency room doctors to treat patients more aggressively, including administering the clot-inhibiting drugs.

More information

Get a primer on heart attacks from the American Heart Association, which also has a page on risk factors for a heart attack.

SOURCES: Mary Ann Peberdy, M.D., assistant professor, internal medicine and emergency medicine, Virginia Commonwealth University Health System, Richmond; Ravi Dave, M.D., assistant professor, medicine, Santa Monica-UCLA Medical Center, Santa Monica, Calif.; Nov. 11, 2003, presentations, American Heart Association Scientific Sessions 2003, Orlando, Fla.
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