Though no time is a good time to have a heart attack, a new study reveals that patients visiting the hospital at night or on the weekend for a heart attack have higher mortality than those visiting during regular hours.
The research, published online by the BMJ, also shows that emergency treatment takes longer for patients visiting outside normal business hours, suggesting that “thousands of extra deaths” each year are a result of factors that occur after patients arrive at the hospital.
According to the study authors, who are based at the Mayo Clinic in Minnesota, heart attacks are the leading cause of death across the world. In the US, 1 million people have a heart attack each year and 400,000 die from coronary heart disease.
Though previous studies have suggested that visiting the hospital outside of regular hours for a heart attack could increase mortality risks, until this latest study, no official reviews or analyses had been conducted.
The researchers therefore analyzed 48 studies from the US, Canada and Europe, which included over 1.8 million participants, to determine any patterns for heart attack patients visiting the hospital during off-hours.
After taking into account differences in design and quality among the studies, the researchers found significant increases in mortality.
Specifically, they found that patients who arrived at the hospital at night or on the weekend had a 5% increase in mortality – either in the hospital or within 30 days of discharge, compared with patients who arrived during regular hours.
Overall, this resulted in 6,000 extra deaths annually in the US.
Additionally, the team found that patients diagnosed with ST elevation myocardial infarction (STEMI) had a delay of almost 15 minutes between when they entered the hospital and when they received an emergency procedure to inflate the coronary artery with a balloon, compared with patients during normal hours.
The authors note that this “could increase mortality by as much as 10-15%,” adding:
“Although the relative odds increase in off-hour mortality seems small, the implications at the population level may be substantial.”
An estimated 900,000 patients check in to hospitals with acute myocardial infarction in the US each year, the researchers say, and two-thirds of the patients check in during off-hours.
However, they add that “1 in 27 in-hospital deaths, or 1 in 29 deaths within 30 days after admission, would be prevented if the higher mortality during off-hours was resolved.”
The research team says further studies need to be conducted that look at the quality of care variation by time of day, including number of staff and expertise levels.
In a linked editorial to the study, doctors from the University of Toronto in Canada write that health care managers “should focus on improving their off-hour care, with the goal of providing consistently high quality care 24 hours a day and 7 days a week.”
“Future studies should try to identify specific deficits in the care pathway during off-hours, allowing differences in outcomes to be linked to differences in processes.”
“Patients deserve the best possible outcome at any given time, and on any given day,” they add.
Researchers from The Scripps Research Institute in California recently created a blood test they say may be able to predict risk of heart attack.