Heart Attack Treatment May Lag in Off-Hours

A new study shows that heart attack patients may get certain hospital treatments faster during the daytime and on weekdays.

But of course, that's no reason to delay heading to the hospital.

The ideal time to have a heart attack is never. It's essential to call for emergency care immediately at the first sign of a heart attack, no matter when it happens.

Researchers working on the study included Harlan Krumholz, MD, MS, a professor at Yale University's medical school. Their report appears in The Journal of the American Medical Association.

What Happens During a Heart Attack?

Researcher's Advice for Patients

Krumholz shared these tips for patients:

—Get help right away for a possible heart attack.

—At the hospital, ask what the treatment plan is and how long it will take.

—Speak up if you have questions or sense delay.

"Every minute counts, whether it's in the hospital or out of the hospital," says Krumholz.

"This article focuses on the need for hospitals to work harder to improve systems, so that once somebody comes to the door that there's not a minute wasted. But patients need to know that every minute that's wasted before they get to the hospital also places them at greater risk.

"So, this is a call for patients to realize that if you think you have the symptoms of a heart attack don't delay at all. Go see your doctor, go to the emergency room if necessary, call 911, but don't delay because those minutes before getting to the hospital are also important. You don't want any time wasted there, either."

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Rocking the Boat?

"For patients, I think it's about being persistently, yet appropriately, impatient," says Krumholz. "There's nothing wrong with ... asking politely about what the plan is."

A family member or other ally could help, says Krumholz. Hospitals may also have patient advocates. "It would be great if there were advocates waiting who were really going to try to help push the system for you, but that's not usually what's available to you," says Krumholz.

"I think the most important thing is to understand what the plan is and how quickly that plan is going to be executed," he continues. "But when you're coming in with a heart attack, you're in a very vulnerable position, and it's very hard to do that. And people are also very reluctant to rock the boat because they need the good will of the people who are taking care of them."

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Thousands of Heart Attack Patients Studied

Data came from more than 100,000 heart attack patients at 421 U.S. hospitals. They needed drugs or surgery to reopen clogged arteries as part of their immediate treatment.

Not all heart attack patients need those treatments, but nearly 30% to 40% do, Krumholz tells WebMD. When needed, the sooner such treatments are done, the better a patient's chance of survival, write the researchers.

Many of the patients had delays before getting artery-opening surgery, especially during "off-hours," which were any time other than 7 a.m. to 5 p.m. on weekdays, write the researchers.

Five Steps to a Healthier Heart

Why the Delay?

The delays that do occur ... tend to be leaking of minutes in all sorts of different directions. It's not like there's one place where all the time is spent," says Krumholz.

"It's just that people aren't moving as quickly, and the systems aren't in place, and there may be some indecision about who's responsible. Issues can even have to do with who's transporting the patient ... how the drugs are being ordered or whether or not the laboratory is prepared. So mostly, this is something that hospitals need to get straight but for patients, I think they need to know that every minute counts."

Visit WebMD's Heart Disease Health Center

Hospital Guarantee?

"The best thing that would happen is that hospitals would guarantee their communities, "You come in here with a heart attack [and] we guarantee you'll be treated within the guideline recommendations. That's what I'd like to see," says Krumholz.

"We're showing that a large percentage of patients even during the regular period aren't being treated within the recommended guideline times. In fact, fewer than half are being treated in regular hours during the guideline time. So this is an issue that pervades the hospital at all times and it's an opportunity for us to do better, in terms of treatment. We really should be having rapid response teams, where everyone has a clear role and that the systems are in place so that everyone gets treated rapidly," he says.

The findings might not apply to all U.S. hospitals, since the hospitals in the study voluntarily participated in a national database. "The very best hospitals have worked this out," says Krumholz.

By Miranda Hitti, reviewed by Brunilda Nazario, MD

SOURCES: Magid, D. The Journal of the American Medical Association, Aug. 17, 2005; vol 294: pp 803-812. Harlan Krumholz, MD, MS, professor, Yale University medical school, director, Center for Outcomes Research and Evaluation, Yale-New Haven Hospital. News release, Yale University. News release, JAMA/Archives.