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Hospitals a bad place to get heart attack
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Fri, Jan 04, 2008
The Straits Times
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NEW YORK - PEOPLE who suffer a life-threatening alteration in heart rhythms are more likely to survive if they are in a casino or airport than if they are in a hospital, a new study released yesterday stated.
Only a third of victims in hospitals survive cardiac attacks - because they do not receive life-saving shocks called defibrillation within the two minutes recommended by major heart organisations, the study stated.
'Most patients assume - unfortunately, incorrectly - that a hospital would be the best place to survive a cardiac arrest,' wrote University of Southern California cardiologist Leslie Saxon in an editorial accompanying the report in the New England Journal of Medicine.
But doctors and nurses do not always run fast enough, and nearly 22 per cent of those who suffer a cardiac arrest in hospitals do not receive defibrillation within two minutes, the report said. As a result, their risk of suffering brain damage and death is higher.
| The study was based on data from a US registry of 6,789 patients in 369 hospitals. The study found that nearly 40 per cent of patients survived when defibrillation was given on time, but there is little hard data available to support the need for a rapid response, the authors wrote.
'We found that delayed defibrillation was common, and that rapid defibrillation was associated with sizeable survival gains in these high-risk patients,' said Dr Paul Chan of St Luke's Mid America Heart Institute in Kansas City, Missouri.
He is the lead author of the study conducted along with Dr Brahmajee Nallamothu of the University of Michigan.
People who suffer a heart attack in the middle of a crowded airport or casino - where defibrillators are widely available - are noticed immediately, whereas a lone patient suffering an attack in a hospital room may not be noticed for much of the crucial window of opportunity during which defibrillation is most effective.
The researchers found that delays in response were more likely at smaller hospitals, on weekends or at nights, and for patients who were not constantly being monitored or were admitted for non-heart problems.
They were also more common for black patients, which could not be explained by the information used for the study, Dr Chan said. He said it could be more because of the quality of the hospitals than discrimination.
Recent attention has focused on getting quicker treatment for heart attacks, the authors wrote.
'We still have a lot to learn as to how to deliver treatment in an effective way,' Dr Chan said.
One potential way to speed up response times is to make automated external defibrillators available throughout hospitals so that nurses could readily use them instead of waiting for doctors to deliver shocks, he said.
As many as 750,000 people suffer such attacks in hospitals every year in the US, and another quarter-million get such attacks elsewhere.
Defibrillation is used when a patient's heart beats abnormally, intermittently or extremely rapidly. The result is an inability to pump blood through the body effectively. Applying a shock to the heart often restores normal heart rhythms.
NEW YORK TIMES, ASSOCIATED PRESS
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