{"id":16235,"date":"2014-01-22T10:33:43","date_gmt":"2014-01-22T15:33:43","guid":{"rendered":"http:\/\/therapytoronto.ca\/news\/?p=16235"},"modified":"2014-01-23T01:11:33","modified_gmt":"2014-01-23T06:11:33","slug":"deaths-higher-for-heart-attack-patients-at-night-and-weekends","status":"publish","type":"post","link":"https:\/\/therapytoronto.ca\/news\/2014\/01\/deaths-higher-for-heart-attack-patients-at-night-and-weekends\/","title":{"rendered":"Deaths higher for heart attack patients at night and weekends"},"content":{"rendered":"

From the BMJ<\/em>–British Medical Journal<\/em> media release:<\/p>\n

\"hospital<\/a>Mortality is higher, and emergency treatment takes longer, for heart attack patients who arrive at hospital during the night or at weekends<\/strong> compared with regular hours, finds a study published on bmj.com.<\/p>\n

The results suggest that presenting outside regular hours may lead to thousands of extra deaths every year. They also show a longer ‘door to balloon time’ — an emergency procedure to inflate the coronary artery.<\/p>\n

Heart attacks remain the leading cause of death worldwide. Every year, around one million people in the United States have a heart attack and 400,000 die from coronary heart disease.<\/p>\n

Previous studies have suggested that heart attack patients who present to hospital during off-hours (weekends and nights) may have higher mortality<\/strong> compared with regular hours, but no reviews or analyses of the evidence have been done.<\/p>\n

So a team of researchers based at the US Mayo Clinic analysed the results of 48 studies involving 1,896,859 patients<\/strong> to assess the effects of off-hour presentation among heart attack patients.<\/p>\n

The studies were carried out in the US, Canada and Europe<\/strong> — and differences in design and quality were taken into account to minimise bias.<\/p>\n

Patients who presented during off-hours had a 5% relative increase in mortality (both in-hospital and 30 days after discharge) than patients who presented during regular hours<\/strong>, resulting in an extra 6,000 deaths every year in the US alone.<\/p>\n

For patients diagnosed with a certain type of heart attack (known as ST elevation myocardial infarction<\/a> or STEMI), the results also show a delay of nearly 15 minutes in door to balloon time for patients presenting during off-hours<\/strong>. This, say the authors, “could increase mortality by as much as 10-15%, assuming linearity between door to balloon time and mortality.”<\/p>\n

Although they cannot rule out differences in underlying patient characteristics, the authors say their results suggest that “increased mortality during off-hours is associated with factors that arise after presentation at hospital.”<\/p>\n

And they call for further studies to explore the variation in the quality of care by time of day<\/strong>, such as number of staff and their level of expertise.<\/p>\n

In an accompanying editorial, doctors at the University of Toronto argue that, patients presenting during off-hours “experience delays in urgent care and worse outcomes<\/strong>, and the gap seems to be increasing over time.”<\/p>\n

They suggest healthcare managers seeking to boost their hospital’s performance for patients with acute myocardial infarction “should focus on improving their off-hour care, with the goal of providing consistently high quality care 24 hours a day and seven days a week.”<\/p>\n

And they suggest future studies “should try to identify specific deficits in the care pathway during off-hours<\/strong>, allowing differences in outcomes to be linked to differences in processes.”<\/p><\/blockquote>\n","protected":false},"excerpt":{"rendered":"

From the BMJ–British Medical Journal media release: Mortality is higher, and emergency treatment takes longer, for heart attack patients who arrive at hospital during the night or at weekends compared… Read more »<\/a><\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[10],"tags":[],"_links":{"self":[{"href":"https:\/\/therapytoronto.ca\/news\/wp-json\/wp\/v2\/posts\/16235"}],"collection":[{"href":"https:\/\/therapytoronto.ca\/news\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/therapytoronto.ca\/news\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/therapytoronto.ca\/news\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/therapytoronto.ca\/news\/wp-json\/wp\/v2\/comments?post=16235"}],"version-history":[{"count":1,"href":"https:\/\/therapytoronto.ca\/news\/wp-json\/wp\/v2\/posts\/16235\/revisions"}],"predecessor-version":[{"id":16239,"href":"https:\/\/therapytoronto.ca\/news\/wp-json\/wp\/v2\/posts\/16235\/revisions\/16239"}],"wp:attachment":[{"href":"https:\/\/therapytoronto.ca\/news\/wp-json\/wp\/v2\/media?parent=16235"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/therapytoronto.ca\/news\/wp-json\/wp\/v2\/categories?post=16235"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/therapytoronto.ca\/news\/wp-json\/wp\/v2\/tags?post=16235"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}