WEST PALM BEACH, Fla., March 14 (UPI) -- If you are rushed to the hospital on the weekend with a heart attack, your chance of getting aggressive, life-saving treatment is less and your chance of dying is greater, doctors said Wednesday.
A massive analysis of what happened to New Jersey patients suffering their first heart attack indicated a 30 percent greater risk of not receiving a catheter-based angioplasty treatment -- known to save lives in acute heart attacks -- if they went to the hospital with chest pains on Saturday or Sunday, than if they were admitted Monday through Friday.
"For every 100 people who go to a hospital on a weekend, probably one person dies unnecessarily," William Kostis, a researcher at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, told United Press International.
"The reason for the excess deaths on weekends is due to a lot of factors, but the major one appears to be less use of angioplasty in those critical first hours of admission," he said in his research paper that will be published in Thursday's editions of the New England Journal of Medicine.
In angioplasty, doctors use X-ray imaging to advance a balloon-tipped catheter through the blood vessels until it reaches the site where a clot is causing the heart attack. The balloon is inflated, crushing the blockage to the wall of the artery and allowing blood flow into the affected heart muscle, lessening damage and sometimes aborting the heart attack in process.
"We know that in certain types of heart attacks this procedure is life-saving," Kostis told UPI. But on weekends, the skilled doctors, nurses and technicians who are needed to perform the catheterization procedure may not be readily available and a window of opportunity for the patient passes.
Kostis reviewed outcomes of more than a quarter million people who were admitted to New Jersey hospitals from 1987 through 2002 for their first heart attacks and studied when happened to them on the basis of day of admission. "We found that there was a consistent difference of about one percent in mortality after one day, after one month and even after one year, depending upon whether you were admitted on a weekend or a weekday."
"However, no one should think that they should wait to Monday if they are having chest pains on Saturday or Sunday," he cautioned. "If you are having a heart attack you need to call 911 and get to a hospital no matter what day of the week it is."
"The implications of this study are that we, as healthcare providers, must be certain that we have systems in place to guarantee the same access to the cath lab on Sunday as on Wednesday," said Kirk Garratt, clinical director of Interventional Cardiovascular Research at Lenox Hill Hospital, New York.
"We've known for a long time that heart attack patients are among the few patient types for whom angioplasty reliably saves lives," Garratt told UPI. He noted that the journal article reported that the increased risk of dying persisted from 1987 to 2002, even though angioplasty was used with increasing frequency for patients admitted on weekdays and weekends.
"However, despite being used more frequently overall, angioplasty was still used only about half as often on weekends as weekdays," Garratt said. "This suggests that whatever barriers kept patients from getting angioplasty in 1987 may still have been a problem in 2002."
"There is a fall off in how aggressively physicians treat patients with heart attacks on weekends," said Thomas Lee, network president of Partners Health Care Systems in Boston. "I didn't expert that the difference would be this significant."
Kostis said that one way to correct the differences in care might be to use the trauma healthcare delivery model. In some areas, paramedics transport accident victims directly to Level 1 Trauma Centers where staffing for serious injuries is always available. He suggested such a system be established regionally for heart disease since "heart attacks are the biggest killer of men and women in the United States."
"At Lenox Hill Hospital," Garratt said, "we've developed a critical system for management of heart attack patients who come to our hospital or our affiliate hospitals, Lutheran Hospital and Jamaica Medical Center in Brooklyn, to assure the same rapid response 7 days a week."
In an editorial that accompanies Kostis' article in the journal, Donald Redelmeier and Chaim Bell at the University of Toronto noted, "the shortfall of weekend medical care is important because the consequences of adverse events cannot always be offset by working harder on subsequent days. ... If the patient dies on the weekend, no heroics on Monday will suffice."
They said that Kostis' work shows that improving hospital cardiac care requires better treatment on the weekend.
