|
E-mail this page to a friend!
Seniors, Women, Minorities Less Likely to Get Acute
Heart Attack Help
Study of transfers to larger hospitals says sickest
being by-passed
March 13, 2006 If you are a senior citizen, a
female or a minority and suffer an acute heart attack, you are not as
likely to be transferred to a larger hospital that offers life-saving
procedures to immediately open clogged arteries, Duke University Medical
Center cardiologists have found.
In their analysis of almost 400,000 U.S. heart
attack patients over the age of 64, the team also found that while heart
attack patients who were not transferred tended to be sicker than those
who were transferred, paradoxically, the sicker patients were those who
would most likely benefit the most from artery-opening procedures, the
researchers said.
"While the medical community is very proficient at
treating complex illnesses like heart disease, there still remain
disparities in the delivery of that care that needs to be addressed,"
said Duke cardiology fellow Jeffrey Berger, M.D., who presented the
results of his analysis March 12, 2006, during the 55th annual
scientific sessions of the American College of Cardiology in Atlanta.
"Our analysis found that in the U.S., patients over
the age of 64 admitted with an acute heart attack to
non-revascularization hospitals and then transferred were younger, more
frequently male, white and at lower risk and had improved survival than
those who remained at the community hospital," he continued.
Specifically, the team found that women were16
percent less likely to be transferred than men. And, compared to white
patients, African-Americans were 31 percent and Hispanics were 47
percent less likely to be transferred. Also, as age increased, so did
the chances of not being transferred.
The finding of such disparities is important, the
researchers assert, since research has shown that even with the added
transfer time, patients with an acute heart attack still fare better
with artery-opening procedures -- such as angioplasty or bypass surgery
than those treated only with powerful clot-busting drugs.
The researchers said their findings should help
give physicians in smaller community hospitals more confidence about
transferring such patients to larger hospitals. The researchers also
said the reasons for such disparities remain to be explored, and that
they are likely multi-factorial.
For his analysis, Berger consulted Centers for
Medicare and Medicaid Services data from 2001 to 2003. During that time,
399,775 patients over the age of 64 suffering from an acute heart attack
were admitted to hospitals that were unable to perform angioplasty or
bypass surgery.
Of those patients, just over one-third (35 percent)
were subsequently transferred to a larger facility with
revascularization capabilities.
In terms of mortality, 8.7 percent of the
transferred patients died; statistical modeling predicted that 8.9
percent of transferred patients would die. For those patients who were
not transferred, 18.5 percent died; statistical modeling predicted that
15.2 percent would die.
"There are many disparities in health care, and
this analysis has uncovered another area of concern," Berger said. "It
is crucial that we implement or enhance systems that help protect
against these disparities and improve the quality of care for all
patients."
"Many studies have shown that angioplasty or bypass
surgery is the option of choice over drugs for the vast majority of
patients suffering from an acute heart attack," Berger continued. "We
are now beginning to appreciate that the sickest of these patients
perhaps would do better if they received a revascularization procedure.
These findings suggest that more patients should be transferred."
Berger said that physicians in smaller community
hospitals may feel that it is too risky to subject heart attack patients
especially if they are older to an ambulance ride to another
facility. His said data from this and future studies should help give
confidence to community hospital physicians about transferring these
patients.
"The national guidelines suggest that patients who
are having an acute heart attack should go to the nearest hospital, and
that every hospital is able to provide a pharmacologic (clot-buster)
treatment," Berger continued. "However, there are a significant number
of patients who cannot take these drugs or do not respond to them."
The main side effect of clot-busting drugs is the
potential for bleeding. According to Berger, many acute heart attack
patients cannot be given these drugs because of the risk of bleeding
within the brain. Also, even after receiving clot-busters, the arteries
do not re-open in every patient, using up time that could have been
better used getting a procedure, he said.
Berger added that more research is needed to better
understand the root causes of these disparities, since they are likely
to be more logistical or systemic in nature than medical. The answers
likely reside in a combination of factors, including patient
preferences, decisions made by health care workers, and institutional
issues.
About this study
Berger began this analysis while at Beth Israel
Medical Center, New York, under senior team member cardiologist David
Brown, M.D., and completed it at Duke. Other colleagues were Nicholas
Wanahita and Samantha Collier, State University of New York-Stony Brook,
N.Y.
Click here to Search SeniorJournal.com for more on
this subject
Click to More Senior News on the
Front Page
Copyright: SeniorJournal.com |
