Heart care all in the timing

Published Aug. 17, 2005|Updated Aug. 25, 2005

A new study finds that heart attack sufferers who go to hospitals on nights and weekends wait longer for an artery-clearing angioplasty than patients during regular hours, increasing their risk of dying.

After-hours patients waited an average of one hour and 56 minutes for what is considered the best treatment for heart attacks in most cases, compared with one hour and 35 minutes for patients during regular business hours.

Current guidelines recommend patients wait no longer than 90 minutes from the time they enter the emergency room. Four out of 10 patients waited more than two hours for a balloon angioplasty, according to the study of 68,000 patients published in today's Journal of the American Medical Association.

Delays raised the risk that patients would die by about 7 percent.

Since two-thirds of heart attack patients showed up at hospitals on nights and weekends, the study suggests that hospitals must find better ways to more quickly bring after-hours staff into cardiac catherization labs, where the angioplasties are performed, said Dr. Harlan Krumholz of Yale University School of Medicine, a study co-author.

"We need to ensure there are systems in place to get patients the best care possible, no matter when they show up," he said.

The wait was less for after-hours patients receiving another common heart-attack treatment _ medication for dissolving blood clots. They waited on average only a minute longer than patients who arrived during normal hours.

The researchers noted that medication treatment is usually administered in emergency rooms, staffed 24 hours a day; but by contrast, most hospitals don't staff catherization labs around-the-clock. Continuous staffing is costly but might decrease wait times. The researchers said another possible solution would be to "cross-train" other staffers to help with off-hour angioplasties.

At Chicago's Northwestern Memorial Hospital, emergency room doctors can call in the cath-lab team without prior approval from a heart doctor, said Dr. Mark Ricciardi, an interventional cardiologist at the hospital.

He estimates that saves 30 minutes, although staff sometimes are called when it turns out not to be necessary.

"We actually don't discourage that," said Ricciardi, who was not involved in the study. "You'd rather come in unnecessarily a certain percentage of the time rather than have delays."