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Patients with MI near route of marathon face higher mortality risk
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Older adults who live nearby a major marathon and experience an acute MI had longer transport times to the hospital and higher rates of 30-day mortality due to associated road closures and EMS divergence, according to a study in The New England Journal of Medicine.
“We have traditionally focused medical preparedness and emergency care availability to address the needs of race runners, but our study suggests that effects of a marathon may spread well beyond the course of the event and affect those who live or happen to be nearby,” Anupam B. Jena, MD, PhD, the Ruth L. Newhouse associate professor of health care policy at Harvard Medical School, physician at the department of medicine at Massachusetts General Hospital and faculty research fellow at the National Bureau of Economic Research, said in a press release.
Researchers analyzed data from patients aged 65 years or older from 11 U.S. cities who were admitted for acute MI or cardiac arrest between 2002 and 2012 in marathon-affected hospitals during a marathon (n = 1,145; mean age, 76 years; 49% women), as well as from similar patients hospitalized 5 weeks before (n = 5,607; mean age, 77 years; 51% women) or after a marathon (n = 5,467; mean age, 77 years; 49%), and those hospitalized the same day of the marathon but in surrounding ZIP codes unaffected by the race.
The primary outcome was 30-day mortality after hospital admission. Another outcome of interest was travel time to the hospital on a marathon date vs. 5 weeks before or after a marathon.
Effects of marathon closures
The number of hospitalizations did not fluctuate between marathon dates (mean per city, 10.6) and nonmarathon dates (mean per city, 10.5; P = .71). Characteristics including race, sex and pre-existing medical conditions did not differ among the various hospitalization dates.
Unadjusted 30-day mortality was 28.2% among those admitted to marathon-affected hospitals on marathon dates vs. 24.9% among those admitted on nonmarathon dates (absolute difference, 3.3 percentage points; 95% CI, 0.7-6; RR difference, 13.3%).
Once adjusted for covariates, 30-day mortality was significantly higher in those admitted to a marathon-affected hospital on a marathon date (28.6%; 95% CI, 26.1-31.1) compared with patients admitted on nonmarathon dates (24.9%; 95% CI, 24.1-25.6; absolute adjusted risk difference, 3.7 percentage points; 95% CI, 1.1-6.4).
Patients admitted to control hospitals did not experience a difference in mortality when admitted on a marathon date (25%; 95% CI, 23.6-26.4) vs. nonmarathon dates (24.7%; 95% CI, 24.3-25.2; absolute adjusted risk difference, 0.3 percentage points; 95% CI, –1.2 to 1.8).
Treatments similar
Hospital location was correlated between marathon and nonmarathon dates, “which suggests that patients were not admitted to different hospitals during marathons,” Jena and colleagues wrote. Researchers did not find significant differences in treatments such as PCI, CABG and mechanical circulatory support among the groups of dates.
Although the number of miles driven by ambulances did not differ on marathon dates, transport times were longer in marathon-affected areas (18.1 minutes) than nonaffected areas (13.7 minutes; absolute risk difference, 4.4 minutes; 95% CI, 1.3-7.5; relative difference, 32.1%; P = .005).
“The organizers of these events need to take these risks to heart when they are planning their events and find better ways to make sure that the race’s neighbors are able to receive the lifesaving care that they need quickly,” Jena said in a press release. – by Darlene Dobkowski
Disclosure: Jena reports receiving grant support from NIH during the conduct of the study and personal fees from Bristol-Myers Squibb, Hill Rom Services Inc., Novartis Pharmaceuticals, Pfizer, Precision Health Economics and Vertex Pharmaceuticals. All other researchers report no relevant financial disclosures.
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