More Cardiac Patients Survive When Doctors Are Away

High-risk cardiac patients are more likely to survive if they are admitted to the hospital when cardiologists are attending national meetings, according to a startling new study.

Researchers at Harvard Medical School (HMS; Boston, MA, USA), the University of Southern California (USC; Los Angeles, USA), the Rand Corporation (Santa Monica, CA, USA), and other institutions conducted a study to analyze mortality and treatment differences among patients admitted with acute cardiovascular conditions during dates of US national cardiology meetings, during which hospital physician staffing and composition may be affected, influencing patient outcomes and treatment patterns.

To do so, they conducted a retrospective analysis of 30-day mortality among Medicare beneficiaries hospitalized with acute myocardial infarction (AMI), heart failure, or cardiac arrest from 2002 through 2011, during dates of two national cardiology meetings, and compared the data with identical non-meeting days in the three weeks before and after conferences. Separate analysis was conducted for major teaching hospitals and nonteaching hospitals, as well as for low- and high-risk patients. The main outcomes measures were thirty-day mortality, procedure rates, and length of stay.

The results showed that 60% of patients with cardiac arrest who were admitted to a teaching hospital during the days when cardiologists were at scientific meetings died within 30 days, compared to 70% of patients who were admitted on non-meeting days. The results also showed that certain intensive procedures were performed less often on high-risk patients during meeting dates. No mortality or utilization differences existed for low-risk patients in teaching hospitals or high- or low-risk patients in nonteaching hospitals.

In sensitivity analyses, cardiac mortality was not affected by hospitalization during oncology, gastroenterology, and orthopedics meetings, nor was gastrointestinal hemorrhage or hip fracture mortality affected by hospitalization during cardiology meetings. The researchers speculate that physicians who did not attend the conferences took a more conservative approach to high-risk patients, and that physicians who stayed behind were reluctant to perform intensive procedures on another physician's patients. The study was published on December 22, 2014, in JAMA Internal Medicine.

“Treating high risk patients the same as lower-risk patients may be bad medicine. We don't have the full set of answers about what works best in these cases, but the evidence suggests that a ‘less is more’ approach might be best for higher-risk patients with these conditions,” said senior author Anupam Jena, MD, PhD, an assistant professor of health care policy at HMS. “Survival rates might be higher because, for high-risk patients with cardiovascular disease, the harms of intensive procedures may unexpectedly outweigh the benefits.”

Related Links:
Harvard Medical School
University of Southern California
Rand Corporation