Journal of Advanced Practice Nursing

Is Hospital Heart Attack Treatment As Good During Off Hours?


SAUSALITO, CA (ASRN.ORG) -- Some research has found that people may be less likely to survive a heart attack if they are treated during hospital "off-hours." But a new study suggests that is not the case -- at least for people treated at larger medical centers well-equipped for handling heart attack victims.

Italian researchers found that of 3,000-plus patients who had a heart procedure done at their network of 28 hospitals, those treated during off-hours -- at night, over the weekend or on holidays -- fared just as well as those treated on weekdays.

Six percent of the off-hours patients died in the hospital, versus 7 percent of "regular-hours" patients. After one year, 8 percent of off-hours patients and 10 percent of those treated during regular hours had died.

When the researchers weighed other factors -- like patients' overall health and the severity of their heart disease -- the timing of patients' treatment remained unrelated to their survival odds.

All of the patients had suffered what is known as an ST-segment elevation heart attack -- the more serious form of heart attack in which an artery supplying the heart with blood becomes completely blocked off.

And most were treated in the network's nine intensive cardiac care units, which perform a high volume of so-called angioplasty procedures each year (at least 80).

During the procedure, a thin, balloon-tipped catheter is threaded into the blood vessels to move aside the blockage causing the heart attack. Then a metal mesh tube, or stent, is left behind to prop open the artery.

This treatment can be life-saving, but some studies over the years have found that they appear less effective for patients treated during off-hours.

Experts have pointed to factors like longer delays to care, hospital staff fatigue, and having less-experienced staff on duty during off-hours.

Dr. Gianni Casella, the lead researcher on the new study, said he believes that hospitals' organizational structure is the key.

In past studies where off-hours patients fared more poorly, he said, "their time to treatment was generally significantly longer."

In the current study, there was a small difference in time to treatment between patients who got stents during off-hours or regular hours, said Casella, a cardiologist at Maggiore Hospital in Bologna.

On average, patients treated during off-hours had the procedure done 88 minutes after arriving at the hospital. That compared with 77 minutes for patients treated during regular hours.

The hospitals in the study, Casella said, had experienced operators on duty round-the-clock, and had set up systems to get patients more quickly from their homes to the "cath lab" where angioplasty is performed.

While the hospitals were in Italy, Casella said there are recent studies from Europe and the U.S. showing similar results.

In general, patients with ST-segment heart attacks are being treated more quickly in recent years, notes Dr. Henry H. Ting.

Heart disease is the leading killer worldwide, with more than 1.2 million heart attacks annually in the U.S. alone.

A recent study of 831 U.S. hospitals found that in 2008, more than 75 percent of patients received a stent within 90 minutes of arriving at the hospital -- the time that guidelines recommend. That was up from only half of patients in 2005.

And there's evidence that off-hours patients are benefiting to a similar degree as patients treated during regular hours.

Ting, of the Mayo Clinic in Rochester, Minnesota, called the latest findings a "wonderful example" of what can be achieved when heart attacks are handled quickly at all times. But there's still room for improvement, he points out.

In the current study, Ting notes, 16 percent of patients were not transferred to hospitals with intensive cardiac care units. And they had a "striking" death rate of between 25 percent and 35 percent.

It's not clear why those patients were not transferred or what treatment they did receive, Ting writes. So an important issue, he says, will be how to further expand heart attack patients' access to timely and adequate help.

Copyright 2011- American Society of Registered Nurses (ASRN.ORG)-All Rights Reserved 


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Editor-in Chief:
Kirsten Nicole

Editorial Staff:
Kirsten Nicole
Stan Kenyon
Robyn Bowman
Kimberly McNabb
Lisa Gordon
Stephanie Robinson

Kirsten Nicole
Stan Kenyon
Liz Di Bernardo
Cris Lobato
Elisa Howard
Susan Cramer