A new study finds that heart attack sufferers who go to hospitals on nights and weekends wait longer for an artery-clearing angioplasty than patients during regular hours, increasing their risk of dying.
After-hours patients waited an average of one hour and 56 minutes for what is considered the best treatment for heart attacks in most cases, compared with 95 minutes for patients during regular business hours.
Current guidelines recommend patients wait no longer than 90 minutes from the time they enter the emergency room. Four out of 10 patients waited more than two hours for a balloon angioplasty, according to the study of 68,000 patients published in Wednesday’s Journal of the American Medical Association.
Delays raised the risk that patients would die by about 7 percent.
Since two-thirds of heart attack patients showed up at hospitals on nights and weekends, the study suggests that hospitals must find better ways to more quickly bring after-hours staff into cardiac catherization labs, where the angioplasties are performed, said study co-author Dr. Harlan Krumholz of Yale University School of Medicine.
“We need to ensure there are systems in place to get patients the best care possible, no matter when they show up,” he said.
The researchers noted that medication treatment is usually administered in emergency rooms, staffed 24 hours a day; but by contrast, most hospitals don’t staff catherization labs around-the-clock. Continuous staffing is costly but might decrease wait times. The researchers said another possible solution would be to “cross-train” other staffers to help with off-hour angioplasties.
At Chicago’s Northwestern Memorial Hospital, emergency room doctors can call in the cath-lab team without prior approval from a heart doctor, said Dr. Mark Ricciardi, an interventional cardiologist at the hospital.
He estimates that saves 30 minutes, although staff sometimes are called when it turns out not to be necessary.
“We actually don’t discourage that,” said Ricciardi, who was not involved in the study. “You’d rather come in unnecessarily a certain percentage of the time rather than have delays.”
The best hospitals require on-call staff to live nearby and respond quickly to their pagers, Krumholz said. Staffs also leave labs set up and ready for the next patients at the end of the regular work day.
The delays in angioplasty treatment occurred at all kinds of hospitals — rural, urban, public and for-profit — across all regions of the country.
In the study, only 26 percent of after-hours patients met the 90-minute guideline for getting an angioplasty. During regular hours, 47 percent of patients did.