Heart attack deaths increase during winter holidays

03/01/04



Trip Meine, M.D.
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NEW ORLEANS -- Duke University Medical Center researchers have now demonstrated what many have long suspected -- heart attack patients admitted to U.S. hospitals during the winter holidays have higher mortality rates than those admitted during the rest of the year.

The researchers also found that during these holiday hospitalizations, patients were less likely to receive drugs and/or procedures that have been proven effective in large clinical trials to save the lives of heart patients.

While there are likely many factors involved in these trends during the holidays, the researchers believe that the U.S. health-care system is not truly organized to operate around-the-clock for 365 days a year.

"The decrease we found in proven treatments and the increased mortality suggests that critical services for life-threatening illnesses such as heart attack need to be maintained at full levels during holiday seasons," Duke cardiologist Trip Meine, M.D., said. "The health-care system needs to run 24-7, and it cannot take a vacation. That includes not just the physicians, but all the other members of the health-care team, as well as hospital and support employees."

Meine presented the results of the Duke analysis March 8, 2004, at the annual scientific sessions of the American College of Cardiology.

The Duke team studied the records of 134,609 heart attack patients maintained by the Cooperative Cardiovascular Project, a database of patients admitted to U.S. hospitals from 1994 to 1996. They compared the treatments and outcomes of those patients admitted during the last two weeks of December and the first two weeks of January to those admitted during the other 48 weeks.

Specifically, patients admitted to the hospital during the holiday weeks were less likely to be prescribed aspirin at admission (77.2 percent vs. 78.2 percent), as well as beta blockers both at admission (43.3 percent vs. 44.8 percent) and at discharge (28.7 percent vs. 30.6 percent).

"Significantly, heart attack patients admitted during this holiday period were less likely to receive angioplasty (12.5 percent vs. 15.3 percent) to open clogged arteries, and had an increased mortality rate (22.5 percent vs. 20.5 percent)," Meine said. "The differences in rates for angioplasty and mortality persisted even after accounting for baseline differences in patient, hospital and physician characteristics."

While previous studies have shown an overall increase in heart attacks during the winter months, the current study showed no differences among regions of the country, suggesting that the increased incidence cannot be fully explained by climate alone, Meine said.

Other studies have found that patients with different types of illnesses tend to have worse outcomes if they are admitted to the hospital on weekends instead of during the week, with the difference felt to be partially attributable to decreased hospital staffing on weekends, he added.

"It is possible that the decrease in the use of proven therapies, such as angioplasty, during the winter holidays is due to reduced hospital staffing," Meine continued. "However, though the rates of angioplasty differed, there was no statistically significant difference in the adjusted rates of overall reperfusion strategies, suggesting that the decreased use of angioplasty was not recognition of the need for reperfusion, but perhaps an inability to utilize the catheterization laboratory during holiday down times."

Meine pointed out that the database they used for comparing treatments and outcomes does not include any information about the staffing levels or economic situation of any of the hospitals.

"However, we suspect that the differences seen during the holidays are due to the stresses and strains of trying to maintain a high level of service with less staffing and resources," he said.

The study was supported by the Delmarva Foundation for Medical Care, Easton, Md., and the U.S. Centers for Medicare and Medicaid Services.

Other members of the Duke team were Manesh Patel, M.D., Venita DePuy, Lesley Curtis, Ph.D., Sunil Rao, M.D., Kevin Schulman, M.D., and James Jollis, M.D.

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