Heart Attack Survival Better When Specialists Are Out of Town
TUESDAY, March 13, 2018 -- Believe it or not, new research suggests that people hospitalized for a heart attack are more likely to survive when certain heart specialists are out of town.
The study of more than 34,000 U.S. heart attack patients found survival rates were higher when interventional cardiologists were attending their annual conference.
Those cardiologists are specialists in using minimally invasive procedures such as angioplasty and stenting to treat a heart attack.
During the annual meeting -- when many interventional cardiologists would be out of town -- about 15 percent of heart attack patients died within 30 days of their hospitalization, the study showed.
In contrast, during the few weeks before and after the meeting, that death rate was just under 17 percent.
Experts said it all suggests that the doctors who stay behind practice differently from those who go to the meeting.
"But we don't yet know what makes them different," said lead researcher Dr. Anupam Jena, an associate professor at Harvard Medical School.
The findings, reported recently in the Journal of the American Heart Association, are not the first to show a link between medical meetings and patients' survival.
In an earlier study, Jena's team found that patients hospitalized for cardiac arrest or severe heart failure tended to fare better during the annual meeting of the American College of Cardiology -- versus non-meeting dates.
"That meeting is attended by cardiologists of all sorts," Jena said. "That left the question, 'Who are the ones whose absence is driving this'?"
In the new study, the researchers focused on the annual Transcatheter Cardiovascular Therapeutics conference, which is called the world's largest interventional cardiology meeting. They looked at 2007-2012 death rates among heart attack patients at U.S. teaching hospitals during the meeting dates, and during the five weeks before and after.
Teaching hospitals are affiliated with medical schools, and many doctors who attend medical meetings work at those centers.
Why were death rates lower during meetings? Jena's team found no signs that heart attack patients were less likely to see an interventional cardiologist during the meeting dates. And they were not less likely to receive stents.
Overall, the study also showed, stent patients fared just as well during meeting dates and non-meeting dates.
Jena said the survival difference was concentrated among a specific group of patients: those who'd suffered a less-severe heart attack and were not given stents -- but received medication and other noninvasive types of care.
In that group, the death rate was about 17 percent among patients who landed in the hospital during the meeting. That compared with almost 20 percent of those hospitalized on non-meeting dates.
The findings are "puzzling," said Dr. Kirk Garratt, president of the Society for Cardiovascular Angiography and Interventions.
Why would the absence of interventional cardiologists affect patients who did not undergo artery-opening angioplasty or get stents to hold arteries open?
The study cannot give the answer -- but it will be important to find out, said Garratt, who was not involved in the research.
"I think this study -- especially on the heels of the previous one -- is screaming for additional research to figure out what's going on," he said.
Jena speculated on one potential explanation: Even when patients do not receive stents, an interventional cardiologist might still be involved in their care when they arrive at the hospital. And the ones who skip the annual meeting might take a different approach than those who attend.
The researchers found no difference in age or experience between cardiologists who attended the meetings and those who didn't. "It's not a matter of younger doctors versus older doctors," Jena said.
But, he noted, doctors who attended the meetings spent more time on research and performed more stenting procedures than those who skipped the meetings.
According to Jena, it's possible those "procedure-oriented" doctors aren't as good at "holistic care" -- including managing any additional health conditions that heart attack patients have.
"There is variability in the ways doctors practice," Jena said, "and it has a meaningful impact on patients' mortality."
Garratt noted that many interventional cardiologists will be reading this study. "And hopefully, it will cause them to reflect on their own practice patterns," he said.
The American Heart Association has more on heart attack treatment.
Posted: March 2018