February 27, 2020

In Sick Heart Patients, Less is More!

In the year 2000, Israeli physicians had a major labor strike during which thousands of elective visits and surgeries were canceled, but paradoxically mortality rates fell dramatically during the same year.

This week in JAMA, Harvard Medical School researchers published a study that found the survival rate for high-risk cardiac arrest patients rose 10% when admitted to prominent teaching hospitals packed with cardiologists for cardiac conventions.

They examined the 30-day mortality rate for 8,570 Medicare beneficiaries who were hospitalized for acute myocardial infarction, heart failure or cardiac arrest on national cardiology meeting dates from 2002 to 2011.  Those rates were compared to similar cohorts admitted three weeks before and after meetings. 

17% of high-risk heart failure patients died on meeting dates, whereas almost 25% died on non-meeting dates.  In high-risk cardiac arrest patients, 59% died on meeting days, 69% on non-meeting days.  Researchers found that teaching hospitals performed 7% fewer angioplasties on high-risk myocardial infarction patients during convention dates.

Researchers wrote that when treating high-risk heart patients, the answer may be that “less is more….One explanation for these findings is that the intensity of care provided during meeting dates is lower and that for high-risk patients with cardiovascular disease, the harms of this care may unexpectedly outweigh the benefits.”

High-risk heart patients are older people with multiple chronic medical conditions such as obesity, emphysema, diabetes, high blood pressure, renal impairment.

In the accompanying editorial and UC San Francisco cardiologist Dr. Rita Redberg wrote “One possibility is that more interventions in high-risk patients with heart failure and cardiac arrest leads to high mortality…Indeed, some high-risk interventions, such as balloon pumps or ventricular assist devices, are being used in populations in which they are not shown to improve outcomes, and recent reports have raised concerns about high rates of fatal complications from pump thrombosis and other problems.”

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