Tuesday, October 11, 2005

More Heart Attack Patients Die in December
By Julie McKeel

People hospitalized with a heart attack are more likely to die in December, according to a study published in the October 4 issue of Annals of Internal Medicine. Similar studies have blamed holiday understaffing, cold weather, or uneven care for the difference. However, in this study, the researchers took these factors into account and still found more patients died in December compared with other months.

Trip Meine , MD

The researchers analyzed data from the Cooperative Cardiovascular Project , a program of the Centers for Medicare & Medicaid Services to improve the quality of care for Medicare beneficiaries hospitalized with acute heart attack. The investigators compared the care and outcomes of 127,959 heart attack patients hospitalized in December with patients hospitalized during other months between January 1994 and February 1996.

Of the 127,959 patients in the CCP database, 14,492 patients suffered a heart attack or MI (myocardial infarction) during December. The December patients were significantly less likely to receive aspirin at admission and to undergo angioplasty. Otherwise, treatment was the same in all groups. Once the researchers factored in the characteristics of the patients, physicians and hospitals, there remained no significant difference between groups in the treatment they were given. However, the death rate at 30 days was higher among December patients (21.7% versus 20.1%).

Results from a previous study showed an increase in heart attacks and death during winter months, independent of geographic region, which suggests that the increase in the heart attacks could not be explained by climate-related factors alone. Another study raised the possibility that the increase in winter death rates is related to the December holiday season, perhaps due to emotional stresses or behavioral changes associated with the holidays.

"Our findings highlight the need for further research into the mechanism of increased mortality in patients hospitalized in December," the group concludes, "while ensuring continued emphasis on standardized care during holiday seasons for patients with acute MI."

No funding was received for this study.

Joining Meine in the analysis were the DCRI's Dr. James Jollis, Dr. Manesh Patel, and Dr. Sunil Rao; Venita DePuy, Dr. Lesley Curtis, and Dr. Kevin Schulman from the Center for Clinical and Genetic Economics (CCGE); and Dr. Bernard Gersh from the Cardiovascular Division of the Mayo Clinic.