Heart Attacks After Hours Are More Deadly, Study Says

Having a heart attack after 5 p.m. or on weekends may be especially hazardous to your health, according to a large study that found that after-hours treatment was significantly slower for many patients.

The study confirms what many doctors have long suspected, that it takes longer during off hours to open a blocked artery with balloon angioplasty, the preferred method at many larger hospitals.

Delays exist both nationally and in Wisconsin, where, during all times of the day, only 36% of patients are treated in the recommended 90 minutes, according to the U.S. Department of Health and Human Services.

The issue is a matter of intense focus at many hospitals attempting to drive down so-called door-to-balloon time (how long it takes to open an artery once a person enters the hospital).

It also has been a marketing ploy for two area hospitals, Wisconsin Heart Hospital, which claims it has the fastest door-to- balloon times in the area, and St. Luke’s Medical Center, which boasts the only 24-hour cardiac catheterization laboratory in the country.

And some hospitals, including St. Joseph Regional Medical Center and St. Francis Hospital, both part of the Covenant HealthCare system, refuse to say how many of their heart attacks patients are treated within the 90-minute national standard for angioplasty.

It’s also a deadly serious matter.

The new study, published today in the Journal of the American Medical Association, found that patients treated during off hours had a 7% greater chance of dying in the hospital. Doctors say longer delays can mean more damage to the heart, which increases the odds of a patient developing heart failure.

“Even during the day in the middle of the week, patients are not getting treated as quickly as they should,” said lead author Harlan Krumholz, a professor of medicine at Yale University School of Medicine. “On nights and weekends, it gets worse.”

But the study found that most patients actually had their heart attacks during off hours between 5 p.m. and 7 a.m. on weekdays or on weekends, raising the issue of whether hospitals are set up to meet the needs of heart attack patients.

The study analyzed data from 1999 to 2002 involving 33,647 heart attack patients who were treated with angioplasty and 68,439 patients who were treated with a clot-busting drug. Both methods are very effective at opening blocked arteries, but at many larger hospitals with cardiac catheterization labs, angioplasty is the preferred treatment.

If angioplasty is used, patients should be treated within 90 minutes, according to national standards.

However, the study found the average treatment time was 95 minutes during regular hours and 116 minutes during off hours.

“There has been precious little change (since 2002),” Krumholz said. “It’s been difficult to budge.”

At Wauwatosa’s Froedtert Memorial Lutheran Hospital, one of the largest hospitals in the area, bringing down door-to-balloon times has been a huge team effort for several years, said David Marks, director of the hospital’s cardiac catheterization lab and associate professor of medicine at the Medical College of Wisconsin.

The hospital now requires that cath lab doctors and personnel who may be called in during off hours live within 30 minutes of the hospital, Marks said. In addition, it no longer requires that EKGs be sent to a cardiologist for interpretation before the cath lab is activated. Now, emergency room doctors make that call, he said.

At UW Hospital, there were similar problems, said Matthew Wolff, chief of cardiovascular medicine.

“There were probably too many phone calls, too many people in the loop,” he said. “We basically applied an industrial engineering approach to the problem.”

While door-to-balloon times have been cut in half, they need to come down more, he said.

At Waukesha Memorial Hospital, a task force now reviews every heart case in which treatment takes longer than 90 minutes, said Victor Hall, executive director of cardiology services.

At St. Luke’s, the nation’s first round-the-clock cath lab opened last year as way to speed up heart attack treatment.

“We have seen a dramatic difference in the numbers,” said Mark Ambrosius, president of the metro region for Aurora Health Care.

At Wisconsin Heart Hospital, which claims to have the best door- to-balloon times in the area, doctors have been able to speed up the process by locating the cath lab only a few steps from the emergency department, said Jack Manley, chief of staff at the hospital.

“We have an inherent advantage,” Manley said.

Even more important than hospitals’ improving treatment times is the need for patients to get to the hospital as soon as their symptoms occur, said Robert Roth, medical director of the cath lab at St. Mary’s Hospital.

The typical patient waits about six hours before going to the hospital.

“My partner had a case the other night of a young woman who waited for 18 hours popping Tums,” Roth said. “She thought she had gas.”

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