ED Diversion Raises Heart Attack Mortality

Cheryl Clark, June 14, 2011

Heart attack patients have a higher risk of dying within a year if the closest ED is on diversion as opposed to operating normally on the day they get sick, according to a Robert Wood Johnson-funded study that is the first of its kind.

"If you have 100 patients admitted to an emergency department with a heart attack, 29 of them are likely to die under normal operations," when the hospital was not on diversion at all that day, within the following year, says Yu-Chu Shen of the Naval Postgraduate School in Monterey, the report's principal author.

"But if [those] same 100 patients had a heart attack on a day when their closest hospital was on diversion for 12 hours or more, the number of patients who would die would go up to 32%. You're going to have an additional three deaths that are potentially avoidable if those patients had not been subject to longer diversion," Shen says.

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Higher rates of 30-day, 90-day and nine-month mortality also occurred in patients whose closest hospital was on diversion, although the difference was not as large as the one-year increased mortality.

The additional deaths occurred not just in the patients who were diverted, but in other heart attack patients who went to that hospital that same day, or the other patients already undergoing treatment at the other hospitals that accepted additional diverted patients.

Presumably, the additional deaths occurred because delays in treatment resulting from busier ED staff or increased transport times equated to greater heart muscle damage, greater oxygen deprivation or other adverse consequences.

The study examined diversion and heart attack mortality in four high-density urban California counties where hospitals admitted 13,860 Medicare patients with acute myocardial infarction between 2000 and 2005. It was published early online Sunday in the June 15 issue of the Journal of the American Medical Association. It was co-authored by Renee Y. Hsia, MD, of the Department of Emergency Medicine at San Francisco General Hospital.


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