April 21, 2008 - Heart attack patients who arrive at the hospital during regular business hours get the fastest, most comprehensive care compared to those who come during off-peak times. Yet, a new study published in Circulation: Journal of the American Heart Association shows the difference does not seem to influence in-hospital death rates.
Previous studies regarding hospital arrival time and heart attack care and outcomes have shown mixed results.
Armed with information from the American Heart Association's "Get With The Guidelines -- Coronary Artery Disease (GWTG-CAD)" database, Hani Jneid, MD, an interventional cardiology physician in training at the Massachusetts General Hospital in Boston, and colleagues compared medical care and in-hospital death rates for 62,814 heart attack patients. The patients were admitted between 7 a.m. and 7 p.m. weekdays or during off-hours, which included weekday overnights, weekends, and holidays.
A little more than half of the study patients arrived during off-hours. Those who did were slightly less likely than the other patients to receive procedures such as emergency angioplasty or a coronary artery bypass graft (CABG), two methods to re-establish blood flow to the heart muscle.
"The goal of [emergency angioplasty] is to open the artery as soon as possible and preferably within 90 minutes of the patient arriving at the emergency room," Jneid says in a news release.
The researchers learned that, on average, those who came to the hospital during regular business hours received emergency angioplasty within a median of 85 minutes; those who arrived during off-hours waited a median of 110 minutes for the procedure.
Patients who arrived during off-hours were 66% less likely to have emergency angioplasty within the 90-minute window recommended by the American College of Cardiology and the American Heart Association.
"This represents a vital opportunity for physicians to improve care, and is particularly important from a public health standpoint," Jneid says. "Our findings should compel healthcare providers and policy makers to work toward 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."
Despite the differences, researchers reported similar death rates for both groups of patients, regardless of sex and age. Researchers say future studies are needed to further examine the role between arrival time and a patient's care and outcome.