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Intense treatments may harm cardiac patients

By ELAINE CHIAO | March 15, 2018

A newly published study from Harvard Medical School revealed that survival rates for heart attacks can sometimes increase when cardiologists are away from their patients at academic conferences. 

For many, this might seem like a puzzling conclusion. How could patients possibly fare better without the support and care of a trained cardiologist?

Anupam Jena, a Ruth L. Newhouse associate professor of health care policy at Harvard Medical School and a physician at Massachusetts General Hospital, as well as the lead author of the study, explained his motive to look further into this research. 

Jena was particularly intrigued in discovering why many medical interventions often do not result in an increase in observed survival rates. 

“The fact that mortality actually falls for heart attack patients during these conference dates raises important questions about how care might differ during these periods,” Jena said, according to ScienceDaily.

When Jena and his research team first started investigating this topic in 2015, they had very different results in mind. 

Initially, they expected to find that there would most likely be no change in survival rate in the presence of other professional staff who could fill in the spots for the absent cardiologist. Alternatively, they thought it might also be possible for there to be a slight decrease in survival rate if other doctors could not up provide the same quality of care for the patients in question.

However, to the researchers’ surprise, neither of the scenarios was actually observed. On the contrary, patients who suffered from acute cardiovascular conditions such as cardiac arrest and heart failure actually recovered more successfully in the absence of a cardiologist.

In other words, on the days where the American Heart Association and the American College of Cardiology summoned all the cardiologists to large-scale meetings, the patients that these cardiologists left behind sometimes ended up faring better without them. 

Jena’s team explored the reason behind this counterintuitive phenomenon. 

According to Jena, many cardiologists would choose to employ more invasive measures for their patients, which does not always yield the best outcome for the patient’s health. In fact, patients who are not severely ill often get better in the long-run from less intense treatment options. 

To delve deeper into confirming his hypothesis, Jena looked through the changes in patient mortality on the dates of Transcatheter Cardiovascular Therapeutics meetings. 

Transcatheter Cardiovascular Therapeutics is currently the world’s largest interventional cardiology meeting. Interventional cardiology focuses on catheter-based management for heart disease, which is typically a much less invasive medical technique than open heart surgery in terms of treating heart attacks.

The direct benefit of this new study is that it targets a more specialized and specific group of cardiologists, as opposed to the team’s previous study in 2015 that included all types of cardiologists. 

Furthermore, Jena and his team discovered solid support that backed up the findings from the 2015 study. 

Before delving into the details, it is important to note that most of the patients in the study suffered from heart attacks that did not call for immediate stenting. 

Stenting generally refers to placing a tiny tube in an artery or a blood vessel to hold the structure open. Patients who receive stenting are equally likely to undergo the procedure with or without a cardiologist, thus it would be harder to compare their survival outcomes.

From examining the statistics of non-stented patients, the team noted that patients admitted to the hospital on non-meeting dates generally suffered a higher mortality rate than patients who went to the hospital with a heart attack on the dates of the meeting, although the difference is not significant. 

Across the board, researchers conclusively observed a more positive outcome when patients are receiving treatment in the absence of a cardiologist.

Despite the initial hypothesis that Jena’s team generated, there might be other more subtle reasons that can accurately justify the difference in mortality rates. 

For example, the physicians who stayed in the hospital during meeting dates might carry out different procedures or routines that turned out to be more successful. Additionally, the type of medications prescribed and the number of side effects that were attended to are all factors that influence the final mortality rate of patients.

Following the recent publication of Jena’s research in the Journal of the American Heart Association, he believes his team still has a long way to go and a list of questions waiting to be answered. 

Most importantly, Jena hopes to find out how other doctors approach heart attack cases and in what ways do their procedures differ from those of the cardiologists away at meetings.

“What we really want to know is how we can close the gap in outcomes and save more lives,” Jena said.

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