Heart Attack Victims Face Greater Risk of Dying When Ambulances Are Diverted

SUNDAY, June 12 (HealthDay News) -- Heart attack patients whose ambulances are diverted from the nearest ER to another one further away are at greater risk of dying -- not just soon after the heart attack, but for up to a year after the intervention, a new study finds.

Researchers examined data from 13,860 Medicare patients who were admitted to emergency departments for heart attack at hospitals in four California counties (Los Angeles, San Francisco, San Mateo and Santa Clara) between 2000 and 2005. Ambulance traffic was diverted from the nearest emergency department to another hospital on an average of 7.9 hours out of 24 hours.

Compared to patients who received care at the nearest hospital, those whose nearest emergency department were diverting ambulances for 12 hours or more had higher death rates after 30 days (19 percent vs. 15 percent), 90 days (26 percent vs. 22 percent), 9 months (33 percent vs. 28 percent), and one year (35 percent vs. 29 percent).

The researchers also found differences in treatment patterns once patients were admitted to the emergency department. Catheterization rates were 49 percent for patients who weren't diverted and 42 percent for those whose nearest emergency department was sending ambulances to a hospital further away for 12 hours or more.

Rates of percutaneous coronary interventions such as balloon angioplasty or stent placement was 31 percent for patients who weren't diverted and 24 percent for patients who were diverted during a 12-hour period or more.

The study appears online and in the June 15 print issue of the Journal of the American Medical Association, and will be presented at an AcademyHealth meeting.

"These findings point to the need for more targeted interventions to appropriately distribute system-level resources in such a way to decrease crowding and diversion, so that patients with time-sensitive conditions such as

Mental Illness Linked to Greater Risk of Death After Heart Attack

FRIDAY, JUNE 3 (HealthDay News) -- People with mental illness are more likely to die following a heart attack or serious cardiac event, a new study finds.

One explanation for this increased risk is that people with mental illness are 14 percent less likely to receive lifesaving treatments for their heart condition, researchers found.

Those treatments included coronary artery bypass graft (bypass surgery) and angioplasty (a procedure to open blocked arteries using a stent), both of which have been shown to improve outcomes for heart patients, researchers said.

The study, published June 1 in the British Journal of Psychiatry, examined 22 published studies that compared the level of care given to those with and without serious mental disorders.

"In 10 studies that specifically addressed care for people with schizophrenia, those with the disease received only half the interventions offered to those without schizophrenia," lead researcher Alex J. Mitchell, of the University of Leicester and University Hospitals of Leicester NHS Trust, said in a news release from the university.

Six studies involving more than 800,000 people found that the risk of death was 11 percent higher in the year after a cardiac event in people with a history of serious mental illness than those without.

"People with known mental health conditions have higher background rates of cardiovascular risk factors such as smoking, inactivity and obesity. We already know that this is reflected in a higher rate of heart disease, but what we demonstrate here is that mortality is greater even after patients come under health care," Mitchell said. "We don't yet know the reason for these poorer outcomes but it is worrying that we also find such patients may receive less frequent lifesaving interventions."

The study authors concluded more research is needed to determine whether patients with severe mental illness are declining treatment or whether physicians are not offering the same level of care to the mentally ill that they offer to their patients without mental disorders.

More information

The U.S. National Institute of Mental Health offers statistics on the prevalence, treatment and costs of mental illness.

SOURCE: University of Leicester, news release, June 1, 2011Copyright