Survival rates among these patients actually improved when cardiologists left town for annual professional meetings, Harvard researchers report.
Sixty percent of patients with cardiac arrest who were admitted to a teaching hospital during one of these meetings died within 30 days, but 70 percent died when these meetings were not taking place.
“That’s a tremendous reduction in mortality, better than most of the medical interventions that exist to treat these conditions,” study senior author Dr. Anupam Jena, an assistant professor of health care policy at Harvard Medical School, said in a university news release.
Medical care is not always clear-cut, particularly for patients with complicated medical histories, explained Jena, who’s also an internist at Massachusetts General Hospital. “This study may help illuminate some of those gray areas and suggest ways we can provide better care for those high-risk patients,” he said.
The researchers compared similar groups of patients treated at teaching and nonteaching hospitals during the annual meetings of the American Heart Association and the American College of Cardiology. They did the same on dates when these meetings were not taking place.
Survival rates for both high- and low-risk patients who had heart failure, a heart attack or cardiac arrest were examined. The study revealed that during the annual cardiology meetings, survival rates increased among high-risk patients diagnosed with heart failure or cardiac arrest. There was no difference in survival rates among low-risk patients and those who had a heart attack.
However, the study only found a link between cardiologists being away and an increase in survival rates among high-risk heart patients. It did not prove cause and effect.
In examining why death rates may have dropped during the meetings, the researchers found that certain intensive procedures, such as coronary artery stenting (when a stent is placed in an artery to prop it open), were ordered less often for high-risk patients during these conferences.
The study authors speculated that doctors who do not attend the annual meetings are more conservative in the way they practice medicine, particularly when it comes to high-risk patients. Another theory is that doctors who cover for their colleagues while they are away at these meetings may be less likely to order intense procedures for high-risk patients who are not their own.
Survival rates at nonteaching hospitals were unaffected by the annual meetings, the researchers noted. One possible explanation for this discrepancy is that more doctors from teaching hospitals attend annual meetings than nonteaching hospitals.
“We don’t have the full set of answers about what works best in these cases, but the evidence suggests that a ‘less is more’ approach might be best for higher-risk patients with these conditions,” Jena said.
Although they were initially surprised by their findings, the researchers concluded that care for high-risk heart patients could be improved by taking a more conservative approach with certain treatments.
For high-risk patients who tend to be older with complex medical histories, the risks of certain procedures may outweigh their benefits. These patients are more vulnerable to certain intensive treatments and may not benefit from them as much as low-risk patients would, the study authors explained.
“Our study provides some evidence that treating high-risk patients the same as lower-risk patients may be bad medicine,” Jena said.
-Mary Elizabeth Dallas
The U.S. Centers for Disease Control and Prevention provides more on survival rates among patients with heart disease.
SOURCE: Harvard Medical School, news release, Dec. 22, 2014
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