Monday, December 28, 2015

Best time to have a heart attack? The week of the national cardiology conference.


"One of the more surprising — and genuinely scary — research papers published recently appeared in JAMA Internal Medicine. It examined 10 years of data involving tens of thousands of hospital admissions. It found that patients with acute, life-threatening cardiac conditions did better when the senior cardiologists were out of town. And this was at the best hospitals in the United States, our academic teaching hospitals. As the article concludes, high-risk patients with heart failure and cardiac arrest, hospitalized in teaching hospitals, had lower 30-day mortality when cardiologists were away from the hospital attending national cardiology meetings. And the differences were not trivial — mortality decreased by about a third for some patients when those top doctors were away. 
Truly shocking and counterintuitive: Not having the country’s famous senior heart doctors caring for you might increase your chance of surviving a cardiac arrest. 
It is not clear why having senior cardiologists around actually seems to increase mortality for patients with life-threatening heart problems. One possible explanation is that while senior cardiologists are great researchers, the junior physicians — recently out of training — may actually be more adept clinically. Another potential explanation suggested by the data is that senior cardiologists try more interventions. When the cardiologists were around, patients in cardiac arrest, for example, were significantly more likely to get interventions, like stents, to open up their coronary blood vessels.
This is not the only recent finding that suggests that more care can produce worse health outcomes."

I wonder also if having the supervisors away at a conference freed the cardiology residents to practice at their best, i.e., to focus on patient care rather than impressing their supervisors. Alternatively, perhaps the residents performed better than usual because they did not want to have to present their supervisors with the news that they had lost patients during the national conferences. It could be that experiencing the supervisor-resident dynamic could be what is bad for cardiac patients. It would be interesting to see data of how the supervisors did without residents around (perhaps when they were sitting for their board exams?).

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