Patients arriving at hospitals in off hours get slower, less care

April 21, 2008

Patients hospitalized with heart attacks tend to get faster and more comprehensive care if they arrive during daytime hours, according to a report in Circulation: Journal of the American Heart Association. But, researchers said, variations in care don’t seem to impact in-hospital death rates.

“Previous studies looking at how patients’ hospital arrival time for heart attack impacts medical care and outcomes have shown mixed results,” said Hani Jneid, M.D., lead author of the study and an interventional cardiology physician-in-training at the Massachusetts General Hospital in Boston.

To determine how hospital arrival time might impact heart attack patients’ care and outcomes, Jneid and colleagues examined data on 62,814 heart attack patients in the American Heart Association’s Get With The Guidelines–Coronary Artery Disease (GWTG-CAD) database.

“The Get With The Guidelines database is a powerful research tool,” Jneid said. “It is a contemporary national clinical registry, which includes a variety of hospitals, including teaching and non-teaching, rural and urban, from all regions of the United States.”

The researchers examined differences in medical care and in-hospital death among heart attack patients admitted during regular hours (7 a.m.-7 p.m. weekdays) versus off hours (7 p.m.-7 a.m. weeknights, weekends and holidays).

Of the patients studied, 54 percent arrived during off hours. After adjusting for baseline characteristics, patients arriving during off hours were 7 percent less likely to undergo primary percutaneous coronary intervention (PCI) and 6 percent less likely to undergo PCI or another type of revascularization called coronary artery bypass graft (CABG) compared with patients arriving during regular hours.

“Emergency angioplasty, or PCI, is the preferred procedure after an ST-segment elevation myocardial infarction, which is a heart attack caused by a completely blocked artery,” Jneid said.

“The goal of PCI is to open the artery as soon as possible and preferably within 90 minutes of the patient arriving at the emergency room.

“In our study, the average time from when the patient entered the hospital to when he or she received the procedure was 110 minutes during off hours compared with 85 minutes during regular hours.”

The researchers also found that arrival during off hours was associated with 66 percent lower odds of achieving the 90-minute window for primary angioplasty that the American College of Cardiology and American Heart Association recommend.

Despite the differences, however, the rate of in-hospital death was similar among patients arriving during off-hours (7.1 percent) versus regular hours (7.2 percent). These findings were similar in men and women and among all age subgroups.

“It is particularly interesting to note that the observed delays in primary PCI did not translate into measurable differences in in-hospital outcome,” Jneid said. “This seems to run counter to previous study findings. Future studies should not only strive to confirm or disprove these results, but also examine variables that might affect the interplay of care and outcome with arrival time.

“This represents a vital opportunity for physicians to improve care, and is particularly important from a public health standpoint,” Jneid said. “Our findings should compel healthcare providers and policy makers to work towards reducing the existing disparities in cardiac care with respect to arrival time, and improve healthcare delivery at all times through multifaceted initiatives aiming to improve the timely delivery of evidence-based therapies.”

Source: American Heart Association

Explore further: Taxing sugary drinks would boost productivity, not just health

Related Stories

Could your office job rob you of vitamin D?

June 22, 2017

(HealthDay)—Spending your days cooped up inside an office might mean you're not getting enough vital vitamin D—know as the "sunshine vitamin," researchers report.

Is it OK to run in heat of 30C or more?

June 21, 2017

Most of Britain is experiencing a heatwave, with temperatures reaching up to 32℃. The public health watchdog for England has issued an amber health warning, advising people to take care in the hotter weather. But what does ...

Recommended for you

Exploring the potential of human echolocation

June 25, 2017

People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...

The ethics of tracking athletes' biometric data

January 18, 2017

(Medical Xpress)—Whether it is a FitBit or a heart rate monitor, biometric technologies have become household devices. Professional sports leagues use some of the most technologically advanced biodata tracking systems to ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.