Off-hours Hospital Visit Delays Heart Treatment

NEW YORK (Reuters Health) - Patients who've suffered a heart attack and visit the hospital during off-hours do not receive angioplasty, a common blood-vessel opening procedure, as quickly as those who show up during regular hours, new research shows. This is particularly concerning since most patients do come during off-hours.

The findings, which appear in the Journal of the American Medical Association, are based on a study of 68,439 patients treated with clot-busting drugs and 33,647 treated with angioplasty between 1999 and 2002. Regular hours were defined as 7 am to 5 pm on weekdays, while all other times were considered off-hours.

Nearly 68 percent of clot-busting patients and 54 percent of angioplasty patients were treated during off-hours, Dr. Harlan M. Krumholz, from Yale University School of Medicine in New Haven, Connecticut, and colleagues note.

The time until clot-busting drugs were given during off-hours was 34.3 minutes, while the time during regular hours was 33.2 minutes, a slight but statistically significant difference. By contrast, with angioplasty, the difference was more pronounced: 116.1 minutes during off-hours compared with 94.8 minutes during regular hours.

The authors also found that angioplasty patients treated during off-hours were less likely to be treated within the time period recommended in treatment guidelines than those treated during regular hours.

Further analysis of the time interval revealed that most of the off-hours delay occurred between obtaining the ECG and patient arrival at the treatment laboratory.

Lastly, showing up during off-hours was associated with a slight but significant increase in hospital death rates, the report indicates.

"To achieve the best outcomes, hospitals providing (heart invention procedures) during off-hours should commit to doing so in a timely manner," the investigators conclude.

SOURCE: Journal of the American Medical Association, August 17, 2005.