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Study: Time of Arrival at Hospital Affects Survival of Heart Attack Patients

Authors note longer door-to-balloon times during off hours

Going to the hospital for a heart attack during evenings, weekends, and holidays increases a person’s risk of dying by 13% compared with people arriving during workday hours, according to new research published in Circulation: Cardiovascular Quality and Outcomes.

Every year, more than 250,000 people experience an ST-elevation myocardial infarction (STEMI) — the most severe type of heart attack, caused by a complete blockage of blood flow to the heart. To prevent death, it is critical to restore blood flow as quickly as possible by surgically opening the blocked vessel or by administering intravenous anticoagulant medications.

“Slower door-to-balloon times for people who arrived at the hospital during off hours are likely due to staffing. In the middle of the night, the hospital catheterization lab where angioplasty and other artery-opening procedures are performed is closed,” said lead author Jorge Saucedo, MD, chief of cardiology and co-director of the Cardiovascular Institute at Northshore University Health System in Evanston, Illinois. “When a heart attack patient comes to the emergency department at 1 a.m., the emergency staff activates the pagers. Doctors need to drive to the hospital and get things set up in the cath lab, and it takes time.”

Researchers compared the care provided to and the survival of 27,270 STEMI patients who arrived during off hours compared with 15,972 STEMI patients who arrived during regular business hours between January 2007 and September 2010 at 447 U.S. hospitals.

Patients who arrived at the emergency room during regular workday hours had an average door-to-balloon time of 56 minutes compared with 72 minutes for patients who arrived during evenings, weekends, or holidays. Guidelines from the American Heart Association (AHA) for the treatment of STEMI patients recommend angioplasty within 90 minutes or less.

The researchers also found:

  • The rate of aspirin administration within 24 hours was nearly 99% regardless of the time that the patient arrived at the hospital.
  • There were no major differences in door-to-electrocardiogram time.
  • The time of arrival at the hospital did not show a major difference in door-to-needle time for the administration of intravenous anticoagulant medications.
  • Almost 88% of patients who arrived during regular weekday hours were treated with angioplasty within the AHA’s recommended 90-minute goal compared with 79% of those who arrived during off hours.

Source: AHA; July 29, 2014.

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