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At Least One-Third of Hospital Heart Care Delivered Too Late

Posted by Jane Akre
Thursday, January 03, 2008 3:08 PM EST
Category: Major Medical
Tags: Medical Devices and Implants, Heart Devices, Heart Rhythm Devices, Pacemakers and Defibrillators

 

Hospitalized patients were delivered timely cardiac shocks too late in one third of the time according to a national survey.

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This is the largest study ever to look at just how effective our nation’s hospital are at delivering care when heart abnormalities strike and minutes count.

Delivering the needed shock via defibrillators within the first two minutes of a heart attack gives the best outcome.  

That’s the scene you see in television dramas like “ER” where doctors and nurses quickly encircle a patient, retrieve the “crash cart” and deliver a therapeutic dose of 300 to 1,000 volts of electrical energy or shock via  paddles to the chest before shouting  “Clear” allowing the heart muscle to reestablish its normal rhythm.

But in more than one third of the cases it took longer to respond and that may be leading to thousands of deaths nationwide every year.  The median delivery time for prompt attention was one minute.

Dr. Paul Chan of St. Luke’s Mid America Heart Institute and the lead author believes one third may be a conservative estimate because the 369 hospitals studied were already being monitored and on track to try and improve their cardiac care outcomes.   

Among the more than 6,000 patients records reviewed for this study, published in Thursday’s New England Journal of Medicine, when intervention is delivered too late only one in five live long enough to leave the hospital. When delivered on time- the odds rise to nearly 40 percent.

Delays were worse if you were black, estimated to be more a function of the hospital than discrimination by personnel based on race, or if your cardiac arrest happened at night or on the weekend when there is less personnel, or in a smaller hospital with fewer than 250 beds.  Poorer outcomes resulted when patients were admitted for something other than a heart condition and were not on a heart monitor.

In some hospitals that did poorly, nurses are not allowed to use defibrillators and must wait for doctors to show up. A delay in treatment translates to a poorer outcome.

It’s estimated somewhere between 370,000 to 750,000 patients in the hospital have cardiac arrest and are recessitated.  In about one third to one half of the cases when a heart beats too fast it can be reset with a shock delivered by defibrillator. 

There is a difference in the delivery of the electric shock from defibrillators.   In some hospital settings defibrillators are connected to an electrocardiogram which tells medical personnel which conditions are shockable while defibrillators found in public areas and casinos are meant to be used by laymen, they sense a heart's rhythm and only deliver an appropriate amount of shock needed to reset the heartbeat.

Dr. Leslie A. Saxon, chief of cardiology at the University of Southern California who wrote an accompanying editorial, says the automatic defibrillators should be used more often in hospitals even without monitors as they are generally foolproof. This is preferable to being in a hospital with no monitor and no personnel around.

But don’t look for a report on your local hospital.  The data was assembled by the American Heart Association and did not name institutions.  #

 


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