Off-hours hospital visit delays heart treatment

NEW YORK (Reuters Health) – Patients who’ve suffered a
heart attack and visit the hospital during off-hours do not
receive angioplasty, a common blood-vessel opening procedure,
as quickly as those who show up during regular hours, new
research shows. This is particularly concerning since most
patients do come during off-hours.

The findings, which appear in the Journal of the American
Medical Association, are based on a study of 68,439 patients
treated with clot-busting drugs and 33,647 treated with
angioplasty between 1999 and 2002. Regular hours were defined
as 7 am to 5 p.m. on weekdays, while all other times were
considered off-hours.

Nearly 68 percent of clot-busting patients and 54 percent
of angioplasty patients were treated during off-hours, Dr.
Harlan M. Krumholz, from Yale University School of Medicine in
New Haven, Connecticut, and colleagues note.

The time until clot-busting drugs were given during
off-hours was 34.3 minutes, while the time during regular hours
was 33.2 minutes, a slight but statistically significant
difference. By contrast, with angioplasty, the difference was
more pronounced: 116.1 minutes during off-hours compared with
94.8 minutes during regular hours.

The authors also found that angioplasty patients treated
during off-hours were less likely to be treated within the time
period recommended in treatment guidelines than those treated
during regular hours.

Further analysis of the time interval revealed that most of
the off-hours delay occurred between obtaining the ECG and
patient arrival at the treatment laboratory.

Lastly, showing up during off-hours was associated with a
slight but significant increase in hospital death rates, the
report indicates.

“To achieve the best outcomes, hospitals providing (heart
invention procedures) during off-hours should commit to doing
so in a timely manner,” the investigators conclude.

SOURCE: Journal of the American Medical Association, August
17, 2005.