Dow Jones Business News
Women, the elderly, blacks and the poor are more likely to wait hours after the onset of heart-attack symptoms before arriving at a hospital for treatment, a delay that significantly reduces their chances of survival, a doctor said Monday.
At the American Heart Association’s 72nd Scientific Sessions, Dr. Stuart Sheifer of Georgetown University Medical Center said 29% of 102,339 Medicare patients surveyed from 1994 through 1996 arrived at the hospital six or more hours after the onset of their first symptoms.
The survey also found those late arrivals stood a 24% greater chance of dying within 30 days and an 18% higher chance of dying within a year.
Factors such as age, race, gender and socioeconomic status were tagged as predictors of late arrival, Sheifer said, adding that high-risk groups should be specifically targeted for educational efforts.
"Delayed hospitalization is a clinically significant problem and should be a target for educational programs," he said.
Doctors and researchers agree that early recognition of heart-attack symptoms and early access to treatment, including CPR and defibrillation, are essential to survival.
Late arrival at a hospital can hinder effective treatment, since some medications and medical procedures must be administered early or not at all.
Meanwhile, researchers at the conference said portable automated defibrillators – which are found in many casinos, airports and convention centers – aren’t widely embraced by hospitals despite indications that the devices can improve a patient’s chances for survival.
As a result, survival rates for patients who suffer a cardiac arrest in a hospital have remained stagnant over the last 30 years, while the survival rate for outside the hospital has grown, said Dr. Mary Ann Peberdy at the Virginia Commonwealth University’s Medical College of Virginia.
Peberdy’s comments came as she reported study results showing that over five years, a team of floor nurses at an unidentified hospital trained to use a "smart defibrillator " defibrillated more patients in under a minute than the hospital’s traditional cardiac-response team – and tallied a higher survival rate.
Smart defibrillators are portable machines that administer an electric shock designed to either jump-start a patient’s heartbeat or regulate an irregular rhythm. The machines are automated so that users require virtually no training or medical expertise, unlike the manual defibrillators used in hospitals.
Because patients don’t have to wait for a doctor to arrive on the scene, they can be defibrillated sooner. And that is essential to survival, researchers agree.
According to some statistics, it can take up to five minutes for a hospital’s cardiac-response team or a doctor to respond to a cardiac arrest outside of an intensive-care unit.
Survival chances for a cardiac arrest victim fall 10% for every minute that defibrillation is delayed, according to some statistics.
But hospitals have been slow to change, Peberdy said. "Many people feel that hospitals function as a self-contained EMS system because they have a tremendous number of health-care providers in a dense area," Peberdy said. "But they need to develop a more systemwide approach approach to responding to in-hospital cardiac arrests."
Peberdy’s study, which involved 210 cases of cardiac arrest in adults, showed a 45% survival rate among the 76 patients treated with the automated defibrillator , compared to a 31% survival rate for the 134 patients treated by the hospital’s cardiac-response team.
Automated defibrillators, which cost about $3,000 apiece, have been used by police and firefighters in many communities for the last several years.
About 10% of the people who suffer a cardiac arrest outside a hospital will survive to be discharged from the hospital, according to figures from Dr. William Groh of the Indiana University School of Medicine, who has been studying the need for greater public access to automated portable defibrillators.
That figure is even lower – about 2% – in rural areas. But in communities that have automated- defibrillator programs, the survival rate is as high as 20%, Groh said.