Hospital a Bad Place to be for Suffering a Heart Attack

By Anastacia Mott Austin

Almost one in three patients who suffer a heart attack while already in the hospital don’t get treatment in time, reveals a new study in this week’s New England Journal of Medicine.

While you might think that a hospital would be the safest place to be if you happen to have a heart attack, it’s just not so, say researchers from St. Luke’s Mid-America Heart Institute. The scientists performed an extensive review of medical records from 6,789 patients at 369 acute care centers for five years, from 2000 to 2005. They studied cases that were "shockable;" in other words, patients whose heart conditions could be treated with an electric shock from a defibrillator.

The records revealed that in 30.1 percent of cases, doctors responded to cardiac arrest patients more slowly than the ideal two-minute window for resuscitation. What is even more sobering is that those statistics worsen when looking at weekend and evening hours, small hospitals, and minority patients.

Another factor to consider is that the hospitals involved in the study were already signed up with a national cardiac registry, said lead author of the study Dr. Paul S. Chan. This indicates that they were likely taking measures to respond to their patients’ cardiac health. So the real-world scenario is probably much worse than the study even indicates.

"Every minute you wait there is 10 percent increase in your risk of death," said W. Frank Peacock, vice chief of emergency medicine at the Cleveland Clinic in Ohio.

Of those who had heart attacks while in the hospital, 40 percent of patients who did receive treatment within the two-minute window survived, compared with 22 percent who survived after getting late response treatment.

"I think it’s something doctors have always known but not thought about," said Dr. Leslie Saxon, cardiology chief at the University of California, who wrote an editorial accompanying the study. "This is the kind of data we need to say, ‘Let’s make sure these preventable things never happen on our watch."

Dr. Chan pointed out that in contrast, the portable, user-friendly defibrillators now found at many public locations like airports and casinos have a great track record for saving lives. Whereas a hospital defibrillator may only be used after an electrocardiogram reading is examined by a qualified doctor or nurse, the portable public defibrillators only have to be attached to the patient, and the device itself measures the heart’s rhythm and automatically determines whether a shock is necessary, avoiding any over-shock scenarios.

The study’s researchers say that these portable devices should be used more often in hospitals. "We know what works, what saves lives," said Dr. Chan. "We have the technology available, and certainly the knowledge and skilled personnel in the hospital to shock patients back to normal rhythm." But, added Dr. Chan, the portable devices could help in situations where a trained physician isn’t readily available, such as small or understaffed hospitals.

Says Chan, "In a small hospital in the middle of the night, the only doctor may be in the emergency room."

Dr. Saxon agrees. She told reporters that the portable defibrillators could potentially save thousands of lives, saying, "You can get them for $500 on eBay. It wouldn’t even take a nurse. You could train the cafeteria workers if you wanted to."