Heart attack patients taken to the hospital on a weekend are less likely to survive than those who have the same emergency on a weekday, researchers reported yesterday. The reason appears to be that hospital staff perform fewer invasive cardiac procedures on weekends, according to the study published in the New England Journal of Medicine.
The added risk is relatively small, about one extra death per 100 admissions per year. Nevertheless, the study suggests that better access to care on weekends - perhaps by having ambulances deliver patients directly to hospitals whose cardiac catheterization teams are on duty - could prevent several thousand deaths a year in the U.S.
An editorial accompanying the paper advises patients who feel unwell during the week not to wait to see whether they feel better by the end of week. At the same time, it emphasized that, in an emergency, patients are "far safer receiving weekend hospital care than staying at home."
Dr. John J. Lopez, a cardiologist at the University of Chicago Hospitals, called the paper intriguing. "We've known for several years that outcomes for patients with heart attacks improve by early angiography and efforts to open the arteries causing the heart attack," he said, referring to an imaging procedure. "This confirms that we should treat patients quickly and aggressively."
Current guidelines for patients with severe heart attacks call for getting them into the "cath lab" so their blocked arteries can be reopened within 90 minutes, Lopez said. For those with less-severe cases, the procedure may be put off for 48 to 72 hours. The current study raises the question of whether all heart attack patients should be treated faster, he said.
In the study, conducted by researchers at the Robert Wood Johnson Medical School and the University of Medicine and Dentistry of New Jersey, a minority of patients were taken to hospitals that perform cardiac procedures on site. However, the researchers found the same weekend-weekday disparity even at hospitals that do such procedures.
The journal editorial, written by two Canadian cardiologists, suggested that health care systems might have to spend money to get more hospital staffers to work on weekends. But Dr. Donald Goldmann of the Institute for Healthcare Improvement said the solution is not necessarily to increase staffing.
For instance, he said, if you discover that most patients develop strokes at night, you can have fewer neurology consultants available during the day.
The institute has been involved in a nationwide initiative to decrease the time from "door to balloon" - from the time the patient arrives at the emergency room to the time the catheter reaches the blockage and inflates the balloon to open the vessel.
As a result of the project, launched by the American College of Cardiology, "things may already have improved" since the study data were collected, Goldmann said.
Judy Peres writes for the Chicago Tribune.