Alan: In Canada, it is increasingly clear that many medical conditions that would elicit quick medical intervention in the States actually benefit from weeks (or months) of watchful waiting. Often, there is no eventual need for surgical/procedural intervention. Since hospital infections and other iatrogenic risks are remarkably high following surgery (and other invasive procedures), it is not surprising that lifestyle modifications involving diet, exercise and pharmaceuticals often result in less morbidity and mortality. In any event, Canadians live several years longer than their American peers despite per capita healthcare spending that is about half what it is in the United States. Check out this eye-popping National Geographic chart: http://paxonbothhouses.blogspot.com/2013/03/national-geographic-chart-of-per-capita.html
Doctors across the United States are treating heart attack victims faster once they arrive at the hospital, but they are not saving more lives, according to a study released this week.
The disappointing results, published Sept. 5 in the New England Journal of Medicine, come from an analysis of 100,000 admissions for heart attacks between 2005 and 2009. Although the hospitals treated patients more quickly with emergency angioplasty, the death rate remained at about 4.7 percent throughout the study, researchers led by the University of Michigan Frankel Cardiovascular Center reported.
The review took place at time when hospitals were making a push to reduce the so-called "door-to-balloon time" -- or the interval between when a heart attack patient arrives in the emergency room and when a catheter with a small balloon at the tip is inserted and inflated to open a blocked artery.
The goal is 90 minutes or less, now one measure of a hospital's quality. Doctors thought they would save heart muscle and lives.
The researchers looked at patients treated for heart attacks at 515 hospitals, and found door-to-balloon time fell from 83 minutes in 2005-2006 to 67 minutes in 2008-2009. But the death rate remained virtually unchanged at 4.8 percent in 2005 and 4.7 percent in 2009.
"Emergency teams and the cardiology community have worked hard with the hope that reducing door-to-balloon time would improve patient outcomes," Dr. Hitinder Gurm, the study's senior author and an associate professor of internal medicine at the University of Michigan Medical School, said in a statement. "These efforts have been widely successful. What's disappointing is that the reduction has not been accompanied by a change in mortality."
Dr. Daniel Menees, an assistant professor of internal medicine at the University of Michigan Medical School and the study's lead author, explained that efforts to reduce door-to-balloon time further might not lower the death rate.
In the rush to provide treatment, hospitals might be taking patients for angioplasties who do not need one and possibly placing them at risk, he said.
To improve care, doctors could focus on better educating people about heart attack symptoms so they can get treatment faster, and on shortening the time for transfers between health-care facilities, he said.
Each year, almost 250,000 Americans have the most serious kind of heart attack called a "STEMI," or ST-elevated myocardial infarction. It occurs when a blocked artery shuts down blood supply to a large area of the heart.
"Heart muscle is dying while a patient is thinking, 'Is this real? Should I call, or should I not call for help?'" Grum said. "We're seeing a fair amount of delay in seeking treatment. That has been harder to fix."
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