Heart attack patients treated with primary percutaneous intervention (PCI) at hospitals after-hours and on weekends wait longer to receive clot busters and other treatments and have a higher risk of death than those treated during regular hospital hours, researchers at the Yale School of Medicine reported in the Aug. 17 issue of Journal of the American Medical Association.
The researchers found that while 67.9% of heart attack patients were treated during off-hours (weekdays 5 p.m. to 7 p.m. and on weekends), the time from hospital arrival to receiving clot dissolving medications varied from only a one-minute longer wait for clot busting medications to a 21-minutes longer wait for PCI therapy.
"The findings suggest that the delayed treatment associated with PCI treatment is associated with a greater mortality risk," says Dr. Harlan M. Krumholz, professor of medicine and public health at the School of Medicine and the director of the Robert Wood Johnson Clinical Scholars Program at Yale.
He adds, "Many patients at night and on weekends have very long delays. This study highlights the need to focus on improving our systems of care during these times for patients who are referred for procedures to treat heart attacks."
Heart attack patients generally receive reperfusion therapy, which consists of either clot-busting drugs to restore blood flow to an organ or tissue, or PCI treatments such as angioplasty where a catheter-guided balloon is used to open a narrowed coronary artery. Reperfusion therapy reduces the risk of death for eligible ST-segment elevation myocardial infarction (STEMI), which is detected on an electrocardiogram after a heart attack. The shorter the time from symptom onset to treatment, the greater the survival benefit with either therapy. Krumholz says that, all things being equal, PCI produces a better outcome, but delays will undermine that advantage.
The study also indicates that even during the day, many patients are not receiving rapid-enough therapy. During the day, fewer than half of the patients undergoing PCI received treatment within the time frame recommended by the national guidelines.
Krumholz and collaborators point out that delays to PCI during off-hours are common to all types of hospitals, including high-volume PCE centers. The authors write that because delays to PCI can result in lower survival rates for STEMI patients, hospitals should commit to providing PCI care in a timely manner. Krumholz and his co-authors suggest that this can be achieved by providing onsite, round-the-clock staffing of the cardiac catheterization laboratory. But the clinical benefits of providing this service must be weighed against the added cost, they note.
Krumholz says other possible solutions include cross-training non-cardiac catheterization laboratory staff to assist with PCI during off-hours and transporting off-hour patients to institutions with continuous cardiac catheterization laboratory staffing.
The National Heart, Lung and Blood Institute funded the study. Data were made available by Genentech Inc. from the National Registry of Myocardial Infarction.
-- By Karen Peart
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W E E K ' SS T O R I E S
University greets its newest freshmen
Freshman Address by President Richard C. Levin
Freshman Address by Yale College Dean Peter Salovey
President of China to speak at Yale Sept. 8
New dean to promote 'values' seminars at SOM
Scientists correct key error in measurement of global warming
ENDOWED PROFESSORSHIPS
Joel Podolny named Beinecke Professor of Management
Emilie Townes is appointed to Andrew Mellon Professorship
Thomas Troeger is designated as the Cox Lantz ProfessorGrant to support research into reducing pain of pediatric surgery
Invitation to Yale community: Meet the new World Fellows
University celebrates Sterling Library's 75th anniversary
Conference will focus on role of religion in public life
Yale engages in special community projects during 'Days of Caring'
Yale hockey star Helen Resor is picked for U.S. Women's National Team
Descendents of John Davenport to converge on campus
The Cinema at Whitney, a new film society, begins weekly screenings
Heart-attack patients seeking after-hours care . . .
While You Were Away: The Summer's Top Stories Revisited
Cell biologist named Bayer Fellow
IN MEMORIAM
Abraham Goldstein, former dean and criminal law scholar
John-Michael Montias, economist and expert on Vermeer
Drama school hosts a memorial tribute to . . . Benjamin MordecaiCampus Notes
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