The danger of heart attack admission on the weekend

Reported by Susan Aldridge, PhD, medical journalist

Patients arriving at hospital with a heart attack during out of hours or weekend have longer times to restoration of normal blood flow.
When someone has a heart attack, the priority has to be to get the blood flowing to the heart again to avoid further damage to the heart muscle. This can be done by clotbusting drugs or by inserting a stent into the blocked artery (angioplasty). The shorter the time between admission and so-called reperfusion - restoration of the cardiac blood supply - the better the outcome.

A team at Kaiser Permanente, Denver, USA, looked at the relationship between time of day and day of week and reperfusion treatment times. Their study covered over 68,000 patients treated with clotbusters and nearly 34,000 treated with angioplasty. Off hours were defined as 5pm to 7am and the weekend. Most patients were treated during off hours - 67.9 per cent in the clotbusting group and 54.2 per cent in the angioplasty group. For the clotbusting group, being treated in off hours took only, on average, a minute longer than being treated in regular hours.

However, when it came to angioplasty, the delay was much longer - 116 minutes from arrival to treatment, on average, in off hours compared to 94.8 minutes in regular hours. This means that more patients do not get treated in the recommended time during off hours. Accordingly, mortality was greater for patients admitted during off hours. Clearly, improvements are needed - for instance, round the clock coverage of the angioplasty department could be considered, although there would be extra costs involved.

Source
Journal of the American Medical Association 17th August 2005 Volume 294 pages 803-812