10 Feb 2009 08:00 AM
Patients Treated By Experienced Doctors In Experienced Hospitals Most Likely To Survive
When it comes to treating heart attacks, experience matters. New research shows that patients have a much better chance of survival when both their hospital and their physician have a strong track record in treating heart attack with angioplasty and stenting.
The new research, published in the February 17, 2009, issue of the Journal of the American College of Cardiology (JACC), found that the risk of dying was cut by nearly half when interventional therapy was performed by an experienced physician in a hospital with plenty of practice in providing the rapid, intense attention that heart attack patients need.
"Even in this day of advanced technology and advanced training, physician and hospital volume still matter, and they matter most in high-risk patients," said V.S. Srinivas, M.B.B.S., an associate professor of clinical medicine at Montefiore Medical Center in New York City. "In coronary interventions, nothing is higher risk than a heart attack."
The study focused on the effect of physician and hospital experience on patients who were treated with primary percutaneous coronary intervention (PCI). In this procedure, a heart attack is treated by inflating a tiny balloon that clears away a blood clot that is cutting off the blood supply to the heart. Usually the interventional cardiologist also places an expandable metal mesh tube, or stent, inside the artery to prop it open.
Today it is widely acknowledged that primary PCI is the safest and most effective treatment for heart attack - provided it can be accomplished quickly. As a result, many communities are establishing primary PCI programs to provide rapid, local care. This trend is raising questions, however. For example, in large cities that already have a primary PCI program, are more programs better for patients, if it means that each hospital and physician performs fewer cases? In smaller communities, can the benefit of having an experienced interventional cardiologist on staff overcome the inexperience of a fledgling primary PCI program that treats only a small number of heart attack patients each year?
The new research provides unique insight into such questions. Although previous studies have looked separately at the influence of physician and hospital experience on survival after primary PCI, this is the first study to evaluate the combined effect of these two factors since stent placement came into common use…
The new research, published in the February 17, 2009, issue of the Journal of the American College of Cardiology (JACC), found that the risk of dying was cut by nearly half when interventional therapy was performed by an experienced physician in a hospital with plenty of practice in providing the rapid, intense attention that heart attack patients need.
"Even in this day of advanced technology and advanced training, physician and hospital volume still matter, and they matter most in high-risk patients," said V.S. Srinivas, M.B.B.S., an associate professor of clinical medicine at Montefiore Medical Center in New York City. "In coronary interventions, nothing is higher risk than a heart attack."
The study focused on the effect of physician and hospital experience on patients who were treated with primary percutaneous coronary intervention (PCI). In this procedure, a heart attack is treated by inflating a tiny balloon that clears away a blood clot that is cutting off the blood supply to the heart. Usually the interventional cardiologist also places an expandable metal mesh tube, or stent, inside the artery to prop it open.
Today it is widely acknowledged that primary PCI is the safest and most effective treatment for heart attack - provided it can be accomplished quickly. As a result, many communities are establishing primary PCI programs to provide rapid, local care. This trend is raising questions, however. For example, in large cities that already have a primary PCI program, are more programs better for patients, if it means that each hospital and physician performs fewer cases? In smaller communities, can the benefit of having an experienced interventional cardiologist on staff overcome the inexperience of a fledgling primary PCI program that treats only a small number of heart attack patients each year?
The new research provides unique insight into such questions. Although previous studies have looked separately at the influence of physician and hospital experience on survival after primary PCI, this is the first study to evaluate the combined effect of these two factors since stent placement came into common use…
