BMJ Study: Do More People Die of Heart Attacks During Off Hours?

Mayo Clinic looked at what happens in the emergency room at different times of the day.

Dr. Richard Besser reports for CBS about a study published online by the British Medical Journal that concluded that having a heart attack at night or during “off hours” is associated with a delay in the start of treatment for heart vessel blockage. The delay is associated with a greater chance of death from heart attack.

The study was actually an aggregate study of 48 studies involving 1,896,859 patients, were included in the meta-analysis. Thirty-six studies reported mortality outcomes for 1,892,424 patients with acute myocardial infarction, and 30 studies reported door to balloon times for 70,534 patients with ST elevation myocardial infarction (STEMI). ST elevation is observed on an EKG in patients in people having a heart attack or myocardial infarction

“Off-hour presentation” for patients with acute myocardial infarction (i.e., a patient presenting symptoms of a heart attack when full medical teams are not available) was associated with higher short-term mortality. Patients with STEMI presenting during off-hours were less likely to receive percutaneous coronary intervention (coronary angioplasty) within 90 minutes, and had longer door-to-balloon time by 14.8 minutes. A diagnosis of STEMI and countries outside North America were associated with larger increase in mortality during off-hours. Differences in mortality between off-hours and regular hours have increased in recent years.

One interesting insight into the study noted that more people that visit the hospital after hours might be in worse shape before they even decide to go to the hospital. In other words, people who don’t feel that bad might wait until normal hours to go to the doctor. If discomfort is bad enough, a person is more likely to visit the hospital — even if its after hours. The scenario affects the study, because it might be that the proportion of sicker people that are more likely to die tend to arrive at off hours.

Every year about one million people in the United States suffer from acute myocardial infarction, and about 400,000 die from coronary heart disease.

See also …
Atsushi Sorita, Adil Ahmed, Stephanie R Starr, Kristine M Thompson, Darcy A Reed, Larry Prokop, Nilay D Shah, M Hassan Murad, Henry H Ting. Off-hour presentation and outcomes in patients with acute myocardial infarction: systematic review and meta-analysis. BMJ 2014;348:f7393

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