For some Medicare patients, the prognosis was better when cardiologists were away from the hospital attending national cardiology meetings.
Anupam B. Jena, M.D., Ph.D., of Harvard Medical School, Boston, and coauthors analyzed differences in 30-day mortality and treatment such as angioplasty (also known as percutaneous coronary intervention, PCI) among Medicare patients hospitalized for heart attack (acute myocardial infarction, AMI), heart failure or cardiac arrest from 2002 to 2011 during the dates of two national cardiology meetings compared with identical non-meeting dates in the three weeks before and after conferences.
Study results show that 30-day mortality in teaching hospitals was lower among high-risk patients with heart failure or cardiac arrest who were admitted during meeting vs. nonmeeting dates (heart failure, 17.5 percent vs. 24.8 percent and cardiac arrest, 59.1 percent vs. 69.4 percent). While mortality for high-risk heart attack patients in teaching hospitals was similar between meeting and non-meeting dates (39.2 percent vs. 38.5 percent), PCI rates were lower during meeting vs. non-meeting dates (20.8 percent vs. 28.2 percent) without any observed effect on mortality.
No mortality or utilization differences existed for low-risk patients in teaching hospitals or for high- or low-risk patients in non-teaching hospitals.
The authors speculate about several explanations for their findings including the physician composition of those who provided hospital coverage while others were away and declines in intensity of care which may include foregoing interventions where the risk-benefit tradeoff was less clear for high-risk patients such as with PCI.
"Our finding that substantially lower PCI rates for high-risk patients with AMI admitted to teaching hospitals during cardiology meetings are not associated with improved survival suggests potential overuse of PCI in this population," the authors write.
The authors acknowledge the major limitation of their study is an inability to establish why high-risk patients with heart failure and cardiac arrest experienced lower 30-day mortality when admitted during national cardiology meetings.
"We observed lower 30-day mortality among patients with high-risk heart failure or cardiac arrest admitted to major teaching hospitals during the dates of two national cardiology meetings, as well as substantially lower PCI rates among high-risk patients with AMI, without any detriment to survival. One explanation for these findings is that the intensity of care provided during meeting dates is lower and that for high-risk patients with cardiovascular disease, the harms of this care may unexpectedly outweigh the benefits," the study concludes.
In a related editor's note, Rita F. Redberg, M.D., M.Sc., editor-in-chief of JAMA Internal Medicine, writes: "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."
Published in JAMA Internal Medicine December 22, 2014 doi:10.1001/jamainternmed.2014.6781.