Tuesday, December 30, 2014

WHAT HAPPENS TO CRITICALLY ILL CARDIAC PATIENTS WHEN CARDIAC SPECIALIST GO ON CONFERENCE LEAVE?

It is important that specialist, whether cardiac or no cardiac, attend medical conferences to update themselves. This is a continuous process that occurs every year, or else, as medical science advances, these specialists will be left behind, out dated. Yet, these specialists or super specialists have patients who may need their help. What happens to these patients should they fall ill when their specialists are away on conference?
Interesting question.
There is a paper out in the Dec 22nd issue of JAMA Int Medicine to address this question. Dr Anupam Jena and coleagues from Mass General, Boston, working in conjunction with RAND corporation, California, looked into this issue. Their paper is entitled, " Mortality and treatment patterns among patients hospitalised with acute cardiovascular conditions during dates of National Cardiology meetings". This is a retrospective analysis of Medicare database.The two cardiac meeting chosen were the American Heart Association Annual Scientific meeting ( year end ),  and the American College of Cardiology, Annual Scientific Meeting ( year beginning ). They study patients records on admission ad discharge and 30 days mortality, for 3 periods, period 1, the 3 weeks before the Meeting, 2. The period of the meeting, and 3 for 3 weeks after the meeting. They screened all admissions for AMI, Heart Failure and Cardiac Arrest, and their 30 days mortality and also their revascularisation rates in the case of AMI.They further divided the data sets into high risk and low risk admissions, and also examined the data from teaching hospitals and non-teaching hospitals separately. Quite comprehensive, I must say. However, this is still a retrospective study.

The results show that for Heart Failure and Cardiac arrest, the overall 30 days mortality was better in the meeting days ( when specialists are away ) than on non-meeting days, especially in the high risk group. There was no difference in the low risk group. As for AMI, they found that there was no difference in mortality between meeting days and non-meeting days, but there was a higher rate of PCI during non-meeting days, meaning that the specialist did more procedures when they were around and yet showed no difference in outcome. As for the low risk group, there were essentially no difference between meeting and non-meeting days, and also teaching and non teaching hospitals.

Interesting. How do we explain this? Does it mean that it was safer with no specialists around? Were they doing more PCIs than the needed to, with no difference in 30 days mortality. Was it that when specialists are away, the staff left behind were more hardworking and conscientious? Or that doing more procedures in AMI did not improve outcome and all the other AMI studies need to be relooked?

There is probably some truth in all the above arguments. I suppose, one thing that we can all agree on is that this is a retrospective study, that there are deficiencies with retrospective studies. However, it does make us ponder. Perhaps this question of "too much specialised cardiac care" may not be doing more good that good average standard care. Or are we doing more and getting less outcomes? Is industry making us do more, just for business?

Interesting thought.

                     HAPPY NEW YEAR 2015
                     to you and all your love ones too.

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