Heart attack patients treated off-hours do as well
The chances of surviving an emergency heart attack procedure may be just as good whether you’re treated on a weekday, weekend or at night, a new study suggests.
The findings come from one large UK hospital. But researchers say the results could extend to similar medical centers, too.
The study, reported in the European Heart Journal, looked at records from 2,571 patients treated for a more serious type of heart attack known as a ST-segment elevation myocardial infarction, or STEMI. Those account for about one-fifth of all heart attacks.
The best treatment for STEMI is emergency angioplasty, where a balloon-tipped catheter is threaded into the arteries to push aside the blockage causing the heart attack. Often, a tiny, scaffold-like device called a stent is left behind to keep the artery open.
One question has been whether STEMI patients who land in the hospital at night or on weekends might fare worse than those who arrive during “business hours.” That’s a possibility because during off-hours, senior staff would likely be on call rather than at the hospital.
In this study, though, patients who had an angioplasty during off-hours were no more likely to die in the hospital: 4.6 percent of them did, versus 4.3 percent of patients treated on a weekday between 8 a.m. and 6 p.m.
Their longer-term outlook was also similar. Over the next year and a half, 11 percent died, compared with 12 percent of patients treated during weekday hours.
What should you do if someone has a heart attack?
A heart attack will cause severe chest pains behind the breast bone, often radiating towards the left arm.
If someone has a cardiac arrest or heart attack, there may be only a few minutes to act before it is too late. It is vital to know what to do beforehand.
To perform CPR (Cardiopulmonary resuscitation) and artificial respiration (mouth-to-mouth resuscitation) effectively, training and frequent practice on resuscitation dummies are essential.
First aid courses are offered all over the country at night schools or by voluntary organisations such as St John Ambulance or British Red Cross.
We highly recommend that you do one of these courses. They are fun, and it’s only by learning what to do in the calm environment of a course that you can reliably deliver care in the highly charged situation of a cardiac arrest.
The study was done in a large hospital that does a lot of cardiac procedures, said Dr. Mohaned Egred of Freeman Hospital and Newcastle University, the senior researcher on the work.
He thinks the results could be similar at other big medical centers with experienced staff and a “robust efficient activation system” that gets STEMI patients into treatment quickly.
“What the public can take away is that if they arrive with a heart attack at a high-volume, well-staffed center, their treatment outcome will be the same whether they arrive during normal working hours or out of hours,” Egred wrote in an email to Reuters Health.
Dr. Gregg C. Fonarow, co-chief of clinical cardiology at the University of California, Los Angeles, agreed there is good news here for patients.
What help is needed?
Immediately place the palm of your hand flat on the patient’s chest just over the lower part of the sternum (breast bone) and press your hand in a pumping motion once or twice by using the other hand. This may make the heart beat again.
If these actions do not restore a pulse or if the subject doesn’t begin to breathe again:
call for help, stating that the casualty is having a cardiac arrest but stay with the patient
find out if any one else present knows CPR. Clearly, use their help if it is available
begin CPR immediately (see below)
provide immediate cardiac massage (‘pumping the chest’, see below), and then artificial respiration.
“Some, but not all, prior studies have suggested that quality of care, rapidity of treatment, and clinical outcomes may be less favorable in (heart attack) patients presenting during off-hours,” Fonarow said in an email.
But in a study of 379 U.S. hospitals, Fonarow and his colleagues found that while off-hours patients waited a bit longer for angioplasty, their survival rates were the same as those of patients treated during weekday hours.