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Outcomes of hospitalized cardiac patients OK when physicians away at cardiology conferences
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Physician attendance at national cardiology conferences away from the hospital does not appear to have a negative impact on the treatment and mortality of Medicare patients admitted for acute MI, cardiac arrest or HF, according to new study findings.
High-risk patients with HF and cardiac arrest admitted to a teaching hospital during the dates of national cardiology conferences had lower 30-day mortality rates compared with patients admitted on other dates. Researchers also found that high-risk patients admitted for acute MI during a conference were less likely to undergo PCI, but no more likely to die than patients admitted when a conference was not scheduled.
“Thousands of physicians attend scientific meetings annually. Although hospital physician staffing and composition may be affected by meetings, patient outcomes and treatment patterns during meeting dates are unknown,” Anupam B. Jena, MD, PhD, and colleagues wrote.
Jena and colleagues conducted a retrospective analysis of treatment differences and mortality rates of Medicare beneficiaries admitted to the hospital for acute MI, HF or cardiac arrest from 2002 to 2011 during the American College of Cardiology and American Heart Association conferences as compared with patients hospitalized on identical non-conference days in the 3 weeks before and after the conferences. Patients were stratified by admission dates (acute MI hospitalizations: n=8,570 for conference dates, 57,471 for non-conference dates; HF hospitalizations: n=19,282 for conference dates, 114,591 for non-conference dates; cardiac arrest hospitalizations: n=1,564 for conference dates, 9,580 for non-conference dates), risk status and hospital type. Treatment rates, length of stay and hospital charges were also investigated.
The primary outcome was risk-adjusted all-cause 30-day mortality after admission for acute MI, HF or cardiac arrest.
Differences in high-risk patients
For high-risk patients admitted to teaching hospitals during conference dates, adjusted 30-day mortality was lower for HF (conference dates, 17.5%; 95% CI, 13.7-21.2; non-conference dates, 24.8%; 95% CI, 22.9-26.6) and cardiac arrest (conference dates, 59.1%; 95% CI, 51.4-66.8; non-conference dates, 69.4%; 95% CI, 66.2-72.6).
“That’s a tremendous reduction in mortality, better than most of the medical interventions that exist to treat these conditions,” Jena, assistant professor of health care policy at Harvard Medical School, internist at Massachusetts General Hospital and faculty research fellow at the National Bureau of Economic Research, said in a press release. “We don’t have the full set of answers about what works best in these cases, but the evidence suggests that a less-is-more approach might be best for higher-risk patients with these conditions. Our study provides some evidence that treating high-risk patients the same as low-risk patients may be bad medicine.”
For high-risk patients with acute MI admitted to teaching hospitals during conference dates, there was no difference in 30-day mortality (conference dates, 39.2%; 95% CI, 31.8-46.6; non-conference dates, 38.5%; 95% CI, 35-42). However, adjusted PCI rates were lower during conferences (20.8% vs. 28.2%; P=.02).
Mortality or utilization by date of admission was not different for low-risk patients admitted to any hospital or high-risk patients admitted to non-teaching hospitals. Adjusted rates of mechanical circulatory support, CABG, length of stay and hospital charges did not vary by admission date for any group.
In a sensitivity analysis, cardiac mortality was unaffected by hospitalization during the dates of oncology, gastroenterology or orthopedics conferences, and gastrointestinal hemorrhage and hip fracture mortality were not affected by hospitalization during cardiology conferences.
Explanations for the findings could include differences between the cardiologists who attend national conferences and those who remain at home; declines during conference dates in the use of interventions that may actually be unnecessary; and possible declines in less-urgent hospitalizations during conferences, enabling staff at the hospital to focus greater attention on remaining high-risk patients, according to the researchers.
Possible overuse
Rita F. Redberg
A possible interpretation of the findings is that “more interventions in high-risk patients with [HF] and cardiac arrest leads to higher mortality,” Rita F. Redberg, MD, MSc, professor of medicine at the University of California, San Francisco, and chief editor of JAMA Internal Medicine, wrote in an editor’s note. “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.”
Redberg, a member of the Cardiology Today Editorial Board, noted that “it is reassuring that patient outcomes do not suffer while many cardiologists are away. More important, this analysis may help us to understand how we could lower mortality throughout the year.”
For more information:
Jena AB. JAMA Intern Med. 2014;doi:10.1001/jamainternmed.2014.6781.
Redberg RF. JAMA Intern Med. 2014;doi:10.1001/jamainternmed.2014.6801.
Disclosure: One researcher is a partner at Precision Health Economics. Jena and Redberg report no relevant financial disclosures.