Heart Attacks Late at Night, on Weekends More Likely to be FatalFeb 22, 2008 | Parker Waichman LLP
Late night or weekend heart attacks might be the most dangerous. New research has found that hospital patients who suffer cardiac arrest at night or on the weekend are less likely to survive than those who have a heart attack during weekdays or weekday evenings. The study was not conducted to determine why this is occurs; however, it's likely that staffing patterns, procedure access, and other systemic issues may explain the difference in outcomes. "Hospitals simply don't work the same at night as they do during the day," explained study author Dr. Mary Ann Peberdy, an associate professor of internal medicine and emergency medicine at Virginia Commonwealth University in Richmond. "There is enough data out there to suggest that this may be a process issue that is at least contributing, and probably contributing substantially."
According to the Institute of Medicine, up to 98,000 preventable in-hospital deaths occur annually in the US; the rate of medical errors is higher at night. Earlier studies also reported that heart attacks treated on a Saturday or Sunday are more deadly than those attended to during the week and Canadian researchers found that strokes treated on the weekend are deadlier than those treated on a weekday.
The immediate cause of poor survival on nights and weekends may be one of timing where there is either a delay receiving critical procedures or in diagnosing the cardiac arrest. "We're literally talking about a difference in seconds, which makes a significant impact," said Beth Mancini, associate dean of Undergraduate Nursing Programs at the University of Texas at Arlington. "It's time for hospitals to look critically at their processes." Mancini is one of the "mothers" of the database used in this study, which is published in the February 20th issue of the Journal of the American Medical Association.
The current study, the most comprehensive of its kind, analyzed survival rates for 86,748 adults who suffered cardiac arrest events in one of 507 hospitals participating in the American Heart Association's National Registry of Cardiopulmonary Resuscitation. Survival was divided into hourly time segments, with day/evening specified as 7 a.m. to 10:59 p.m., night as 11 p.m. to 6:59 a.m., and weekends as 11 p.m. Friday to 6:59 a.m. Monday. Overall survival was 14.7 percent for nights/weekends, and 19.8 percent for weekdays. Although individuals do undergo physiological changes at different times of the day, the authors ruled out most of these changes. There were no survival discrepancies in the emergency department and trauma services.
"Emergency departments are one of the only places in the hospital that are typically staffed the same 24 hours a day and also have attending senior-level physicians available 24 hours a day," Peberdy said. "[Other areas of] the hospital often have doctors-in-training who respond to the cardiac arrest. That suggests this may be a process issue." There may be other such process issues. For instance, in one hospital, Mancini said, certain doors are locked at night, taking it longer to get a patient to a defibrillator. Even physician fatigue at the end of a shift could play a role. "This paper really needs to go to hospitals, and the people who run them," Peberdy said