Weekend heart attacks riskier
TRENTON, N.J. – Heart attack patients have a slightly higher risk of death if they go to the hospital on the weekend, when they are more likely to miss or wait longer for crucial treatments, one of the largest studies of the issue finds.
Though the increased risk of death is small, roughly 5 percent higher in the month after an attack occurs, it can mean potentially thousands more deaths in the United States annually. The study indicated that weekend patients waited longer for angioplasty and other procedures, likely because of reduced staffing.
Even so, doctors say you shouldn’t avoid a weekend hospital visit if you think you are having a heart attack or stroke. A delay of even an hour or two raises chances of death or serious heart or brain damage.
The new study of nearly a quarter-million first-time heart attack patients in New Jersey reflects what smaller previous studies have shown about weekend medical care. Recently published Canadian research also showed stroke patients hospitalized on weekends had a higher chance of dying than those admitted on a weekday.
In the latest study, published in today’s New England Journal of Medicine, researchers at Robert Wood Johnson Medical School in Piscataway, N.J., used a huge statewide database. They tracked 231,164 patients admitted for a first heart attack from 1987 to 2002. They looked at trends over four-year periods, partly because of major advances in heart attack treatment over that time, including new clot-busting drugs, artery-clearing angioplasty and tiny devices called stents that prop open cleared-out arteries.
In the most recent four-year period, when care was much the same as today, patients admitted on a weekend were about 7.5 percent more likely to die within a month than those admitted on a weekday. After adjusting for factors such as age and other medical problems, the death rate was 5 percent higher for those admitted on weekends, said the lead researcher, medical student William J. Kostis.
He said the difference in outcomes was obvious by the day after admission and amounted to 1 in 100 patients each year.
Dr. Harlan Krumholz, a Yale University School of Medicine cardiologist, said differences in staffing levels and communication may play a role in the different death rates. His research team in 2005 found that heart attack sufferers waited 20 to 30 minutes longer for angioplasty on weekends or after hours.