This is a GREAT day to have a cardiac arrest!!!

I thought that headline would get your attention.  Okay, so actually, yesterday would have been an even better time to have a cardiac event, but today’s still good.  March 17-19, the American College of Cardiology was meeting in Washington, DC.  Lots of top cardiologists were away from their hospitals and not seeing patients.  Today I assume they are mostly in the air, on their way home.

Now, you might think, this is a terrible time to need cardiac care, because there are fewer specialists available.  You would predict that on average, people needing cardiac care would do worse during these big national conventions.  In fact, the opposite turns out to be true.  An article published in JAMA shows that patients admitted to teaching hospitals with high-risk heart failure or cardiac arrest, did significantly better when cardiologists were away at these conventions.[i]   The benchmark chosen by the researchers was 30-day mortality.  Of high-risk patients admitted with heart failure during meeting dates, 17.0% died within 30 days compared with 24.8% admitted on nonmeeting dates.  Similarly, 59.0% of patients admitted to teaching hospitals with cardiac arrest during meeting dates died within 30 days compared with 68.6% on nonmeeting dates.

When Anupam Jena, the lead author, was interviewed on NPR’s Freakonomics, he explained the magnitude of the results. “The mainstays of treatment for heart disease are beta blockers, statins, aspirin for some individuals, a blood thinner like Plavix. If you were to combine all those therapies together, we’re probably talking about reducing your mortality by about 2 to 3 percentage points.”  Whereas just going to the hospital when the cardiologists are at a meeting reduces your mortality by 8 and 10 percentage points. WOW!

So what might explain this result?  We can’t know for sure, but Aaron Carroll of my favorite blog, The Incidental Economist, has some ideas.[ii]  Maybe the best cardiologists stayed home. Maybe fewer invasive procedures were done, leading to better outcomes.  Maybe the hospital triaged patients, told the low-risk ones to stay home, and concentrated on the high-risk patients, leading to better care.  But as Carroll says, “Whatever is different during the meetings, it’s associated with lower intensity care and better outcomes.”

In other words, as is so often the case in medicine, less is more.

 

[i] Anapum B. Jena, Vinay Prassad, Dana P. Goldman, et al. Mortality and Treatment Patterns among Patients Hospitalized with Acute Cardiovascular Conditions During Dates of National Cardiology Meetings.  JAMA Intern Med. 2015;175(2):237-244.

[ii] http://theincidentaleconomist.com/wordpress/patients-do-better-when-cardiologists-are-away-at-academic-meetings/

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