Better Outcomes for Heart Patients When Their Doctors Are Away

Boy, talk about less is more! A recently published study showed that if you’re having symptoms of serious heart trouble and your cardiologist is out of town, you’re more likely to live.

The report, published in JAMA Internal Medicine, followed frail patients who were admitted to teaching hospitals with two common types of heart problems. Their admissions coincided with national cardiology conferences, so many of their doctors were unavailable to treat them.

As described in a story on KaiserHealthNews.org, (KHN) the JAMA study showed that heart-attack patients who were at higher risk of dying were less likely to undergo an angioplasty – a procedure to open a blocked or narrowed coronary artery with an inflatable balloon inserted via small tube – when conferences were occurring. But their mortality rates were the same as patients with similar symptoms but who were admitted to the hospitals at other times.

Angioplasty is one of the most common medical procedures for cardiac patients.

The study results surprised even its authors, especially because it involved teaching hospitals. The researchers had anticipated that death rates for their patients would rise at times when cardiology conventions occurred, due to short-handed staffing. Instead, they found the opposite, and were led to speculate that for very weak patients, the risks of aggressive treatment might exceed its benefit.

The study analyzed what happened to Medicare patients admitted to 263 major teaching hospitals between 2002 and 2011, during the annual meetings of either the American Heart Association or the American College of Cardiology. They draw thousands of medical professionals who want to hear about the latest research, therapies, drugs and technologies, not to mention network and socialize.

As KHN explained, for patients with heart failure, heart attacks or cardiac arrest, the study looked at death rates in the hospital or within 30 days of leaving and compared them with the rates for patients hospitalized on the same days of the week during the three weeks before the conferences started and the three weeks after.

The lower death rates during conferences applied only to high-risk patients in teaching hospitals; there was no change in mortality for high-risk patients in other facilities. And most patients who were in better health did not show a greater chance of dying if they were hospitalized during a conference.

Not quite 1 in 5 high-risk patients with heart failure (the heart does not pump blood as well as it should) died on conference days, but 1 in 4 died on days when there was no meeting. The difference was even more pronounced for patients with cardiac arrest (the heart isn’t pumping blood at all). Almost 6 in 10 cardiac arrest patients died while conferences were underway, but almost 7 in 10 died on other days.

The researchers suggested that cardiologists who attend conferences are more likely to do aggressive medical treatments such as complex angioplasties than doctors who don’t attend conferences. We’ve often commented that many medical providers are highly motivated to use the newest, coolest (and often most expensive) treatment, especially in a fee-for-service situation. (See our blog, “How the Profit Motive Feeds the Risks of Coronary Stents.“)

Invasive treatments often save lives, but they carry significant risks of infection and other complications, some of which are deadly.

The JAMA researchers also thought that maybe when a patient’s primary cardiologist is out of town, a fill-in doctor might be less inclined to perform an aggressive intervention. But the researchers weren’t able to find evidence that procedures were being performed less frequently for heart failure or cardiac arrest patients during conference dates. The study’s lead author told KHN that aggressive procedures, such as placing catheters into neck veins to measure the heart, can cause complications but are not always easy to identify in the Medicare billing data used in the study. (See our blog, “Hospitals’ Profit Soars on Wings of Unnecessary Heart Procedures.”)

The researchers wondered if fewer patients undergo elective procedures during cardiac conferences, which would give the on-call doctors more time to focus on the urgent cases. But the researchers didn’t find a decrease in the number of heart patient admissions during conference days, nor did they find a difference in the general health of patients hospitalized on meetings days versus those admitted at other times.

One more possibility, the lead author told KHN, “is that the doctors who leave are primarily researchers and they don’t take care of as many patients as other doctors, so they are worse doctors.”

According to KHN, heart attack patients were just as likely to die on conference dates as other dates. But more than 1 in 5 received angioplasties or stents when conferences were going on, fewer than the nearly 3 in 10 who received these interventions other times.

Said the lead author, “Patients at the very least are no worse off and in fact they may be better off by having less stenting.”

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