Lower Mortality Observed Among Patients Hospitalized During National CV Meetings

A new study published in the JAMA: Internal Medicine observed lower 30-day mortality among high-risk patients with acute myocardial infarction (AMI), heart failure or cardiac arrest hospitalized during the same timeframes as the ACC and the American Heart Association’s annual meetings.

Study investigators conducted a retrospective analysis of 30-day mortality among Medicare beneficiaries hospitalized from 2002 through 2011 during the dates of the two national cardiology meetings. These findings were compared with identical non-meeting days both three weeks before and three weeks after the conferences. Overall results suggested 30-day mortality was lower among high-risk patients with heart failure or cardiac arrest admitted to a teaching hospital during meeting dates versus non-meeting dates (HF: 18 percent vs. 25 percent, p< .001; Cardiac arrest: 59 percent vs. 69 percent, p=.01). High-risk patients with AMI showed similar mortality between meeting and non-meeting dates, while mortality for low-risk patients did not differ. Rates of PCI were also lower among high-risk AMI patients admitted during meeting versus non-meeting dates (21 percent vs. 28 percent, p=.02).

Study investigators also noted that rates of diagnostic catheterization of the right side of the heart or invasive hemodynamic monitoring with tailored therapy did not vary between meeting and non-meeting dates. In addition, no difference was seen in the mortality of low-risk patients admitted to teaching hospitals during meeting compared to non-meeting dates, nor for high- or low-risk patients in non-teaching hospitals.

The authors speculate on possible reasons for their observations. They note that the “mortality results for high-risk patients in teaching hospitals are unlikely to be explained by patients delaying care.” Instead, they attribute the mortality results to possible differences in diagnostic and procedural capabilities of the attending physicians who did not attend the national meetings; declines in intensity of care during meetings; and the ability of physicians to give greater attention to high-risk patients due to declines in admissions of less urgent cardiovascular patients during meeting dates.

“These study findings are interesting observations that require additional study,” said ACC President Patrick T. O’Gara, MD, FACC. “A causal relationship between physician staffing patterns and hospital mortality rates cannot be drawn.”

The study investigators point out that the principal limitation of the study “was an inability to establish the mechanism by which high-risk patients with heart failure and cardiac arrest experienced lower 30-day mortality when admitted during dates of cardiology meetings.”

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Implantable Devices, SCD/Ventricular Arrhythmias, Acute Heart Failure

Keywords: American Heart Association, American Medical Association, Catheterization, Heart Arrest, Heart Failure, Hemodynamics, Hospital Mortality, Hospitals, Teaching, Medicare, Myocardial Infarction

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