January 22, 2014
News Review From Harvard Medical School -- Study: Off-Hours Heart Attacks More Deadly
Your chance of dying from a heart attack is greater if you seek care at night or on a weekend, a research review finds. The study put together results from 48 earlier studies. They included nearly 1.9 million patients. The studies were from the United States, Canada and Europe. People who arrived at hospitals during off-hours had a 5% higher risk of death in the hospital than those who came in on weekdays. The risk of death within 30 days was also 5% higher. Researchers estimated that this led to 6,000 extra deaths each year in the United States alone. One possible reason for the difference is treatment delays during off-hours. The study estimated that for one common type of heart attack, a 15-minute delay could increase death by 10% to 15%. The journal BMJ published the study online. A related editorial in the same journal said treatment delays during off-hours seem to be getting worse. The authors urged hospitals to work to ensure that people get the same high quality of care at all times. HealthDay News wrote about the study January 21.
By Reena L. Pande, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
In the last several decades, we have made tremendous improvements in heart attack care. Nonetheless, there is much work to be done. Heart disease remains the No. 1 cause of death in the United States for both men and women. In fact, heart disease leads to more deaths than all causes of cancer combined.
A heart attack occurs when the blood supply to the heart muscle suddenly becomes blocked. This typically happens when a blood clot forms in one of the heart's blood vessels. These are called coronary arteries.
Recognizing the signs of a heart attack and getting urgent care are the most important first steps. In many cases, someone having a heart attack can be treated through cardiac catheterization. A tube is threaded through an artery to the blockage. A balloon attached to the tube is used to open the blockage. Then a stent, a wire mesh tube, is put in place to hold the artery open. The sooner the blockage is opened, the better.
We don't usually think that the time of day you get care matters. But a new study suggests that people who come to the hospital with heart attacks at off hours (nights and weekends) have a slightly higher risk of dying than those who come in during weekdays.
Why might this happen? There are several theories. People may be more likely to delay coming to the hospital at night or on weekends. And hospitals may be less well staffed during off hours. This might lead to delays in getting urgent heart attack treatment.
What Changes Can I Make Now?
1. Recognize the signs. The most important thing you can do, for yourself or for your friends or family members, is to recognize the symptoms of a heart attack.
Symptoms can include:
- Chest discomfort -- This is often described as pain, pressure, tightness, heaviness, aching or even heartburn. Some people say they feel like there's an elephant sitting on their chest or a vise-like grip around the chest.
- Arm, neck or jaw pain
- Nausea or vomiting
- Shortness of breath
2. Do not delay care. If you are concerned you may be having a heart attack, get evaluated and treated as soon as possible. The longer you wait, the more chance you have of complications or even death. Even at night or on a weekend, do not delay getting treatment.
3. Call 9-1-1. If you think you are suffering a heart attack, do not get in your car and drive to the hospital. Instead, call 9-1-1. Emergency providers have medicines to treat you in your house or on the way to the hospital. They often are also able to call in advance to alert the hospital that you are coming. This helps the hospital to get the medical team you need in place. Emergency providers also will know which hospitals are best equipped to deal with someone having a heart attack.
What Can I Expect Looking to the Future?
We have made great strides in heart attack care, but we can continue to improve. We need to better understand whether the findings of this study are caused by hospital factors or by patients delaying care. Either way, we should continue to educate the community about heart attack symptoms and care. And we should strive to improve hospital systems to ensure that all patients get the best care at any time of day or night.