To Patients With Heart Conditions, It's OK For Your Cardiologist To Take Time Off
ROBERT SIEGEL, HOST:
Here's a frightening scenario. You've gone into cardiac arrest and you're rushed to the nearest teaching hospital. But when you get to the ER, most of the cardiologists are out of town. They're all in Miami Beach for a conference. Bad timing? Or might it be a lucky break? Well, a study published today out of Harvard Medical School takes a look at just this not uncommon situation, and it has some surprising findings. Dr. Anupam Jena is one of the authors. He's an internist, also an economist and he joins me now.
Welcome to the program.
ANUPAM JENA: Thank you for having me.
SIEGEL: And I think that most people would assume that survival rates would be worse with the cardiologists away at a conference, but that's not what you found.
JENA: That's exactly right. Our initial hypothesis was actually that outcomes would be worse because cardiologists would be away and that hypothesis was supported by a number of prior studies which showed that patients who are hospitalized on weekends or on off-hours, such as after midnight, tend to do worse. But what we found was that the complete opposite. These patients who are hospitalized during the dates of cardiology meetings do dramatically better.
SIEGEL: There are three conditions that you considered here. Why don't you describe them?
JENA: The three conditions that we considered are cardiac arrest - cardiac arrest is a condition in which the heart stops pumping. The second condition that we looked that was high-risk congestive heart failure. Heart failure is a condition where the heart stops pumping blood effectively but is still able to pump. And the last condition that we looked at was heart attacks, and again, we looked at high- risk patients, so these are all conditions which are very severe.
SIEGEL: Now, as I understand it in the case of heart attacks there's no big difference whether the cardiologists are away at a conference or not. But in the other two conditions there is.
JENA: Large effects. If you're hospitalized on the date of a national cardiology conference, after 30 days, 60 percent of people with cardiac arrest are dead. If you're hospitalized just a few days before or a few days after, your mortality rate at 30 days is 70 percent.
SIEGEL: OK - theory time. What could conceivably explain that disparity?
JENA: What we found was that rates of coronary stenting fell by about a third for patients who are hospitalized with high-risk heart attacks during meeting dates compared to non-meeting dates. And the way we interpret that is to say here is a measure of the intensity or invasiveness of care that is provided normally. And during the meetings when cardiologists are away that intensity of care, that level, falls. And in my view, I think what's going on is that there are certain types of patients who would benefit from a procedure and others who would not. And the ones who would not, who'd normally get these procedures, for them the harms outweigh the benefits. But when we withhold those procedures on the days of these meetings because cardiologists are away, they can actually do better.
SIEGEL: Well, what have your friends the cardiologists had to say about this study which suggests that you're (laughter) better-off with some heart problems than the cardiologist is out of town?
JENA: I had a lot of friends who were cardiologists. I don't know if I have any friends anymore.
JENA: But I'll tell you, the basic idea is that we assume in medicine that everything is black and white when in fact there are many clinical decisions that are made that are very gray. It very well could be the case that doing more actually harms patients, and I think this is an example at least suggestive of that principle.
SIEGEL: Well, Dr. Anupam Jena of Harvard Medical School, thank you very much for telling us about it.
JENA: Thank you so much.