Heart care differs during hospital "off-hours"

NEW YORK (Reuters Health) - Heart attack patients who arrive at the hospital at night or on weekends or holidays undergo fewer overall procedures to open clogged arteries and have significantly longer wait times for these procedures than their counterparts who arrive during the day, new study findings indicate.

However, arrival time does not appear to affect overall in-hospital death rates.

Previous studies showed inconsistent associations between the time of arrival of patients with heart attack and their medical care and treatment outcomes. Dr. Hani Jneid, from Massachusetts General Hospital in Boston, and colleagues used a nationwide registry to compare outcomes among heart attack patients admitted on weekdays between 7 a.m. and 7 p.m. versus those admitted during off hours (weeknights, weekends, and holidays).

The cohort consisted of 62,814 heart attack patients admitted to 379 hospitals between 2000 and 2005. Overall, 54 percent arrived during off-hours.

In the overall group, in-hospital death rates did not differ between regular hours and off-hours. However, heart attack patients arriving on off-hours were slightly less likely to undergo angioplasty procedures, the investigators report in the journal Circulation.

One third of patients had a type of heart attack called an ST elevation myocardial infarction, or STEMI, which generally occurs when one of the blood vessels feeding the heart becomes completely blocked. In this subgroup, the overall rate of successful re-opening of the blocked artery was not affected by arrival time, but treatment during off hours was more apt to consist of giving drugs to a clear blockage rather than performing angioplasty.

The time it took to administer clot-busting drug therapy was not affected by time of arrival, but median time to initiate angioplasty was longer during off hours.

The researchers note that the higher rate of clot-busting therapy "may reflect an appropriate clinical decision on the part of 'off-hour' physicians" to use this type of therapy when prompt angioplasty is not feasible.

They conclude: "Healthcare providers should continue to work to enhance the healthcare system during regular and off-hours and to reduce existing disparities in cardiac care through multifaceted initiatives aiming to improve the timely delivery of evidence-based therapies.

SOURCE: Circulation, online April 21, 2008.