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Does Time of Year Impact Heart Patient Outcomes?

Friday, January 31, 2014 - Campus News - Contact Theresa Green, (405) 833-9824

New research from the University of Oklahoma Health Sciences Center reveals time of year has no impact on the success of heart catheterization procedures.
For some time, there has been the perception that time of year - especially the time when new doctors are beginning their fellowships at hospitals nationwide - can impact outcomes of a variety of medical procedures. 

"This time period is a perceived vulnerable period when you have new trainees starting who aren't as experienced. It is perceived that this inexperience might adversely impact patient care," said Dr. Beau Hawkins with the OU College of Medicine’s Cardiovascular Section of Internal Medicine.  

A fellowship is a part of medical specialists training. It follows the physician’s completion of a specialty training program, also known as a residency. During this time, the physician is known as a fellow. Fellows may serve as an attending or consulting physician in the general field in which they trained, such as internal medicine. After completing a fellowship in a relevant sub-specialty like cardiology, the physician may practice without direct supervision by other physicians in that sub-specialty.

Hawkins and the team set out to determine if time of year had an impact in interventional cardiology, a field of medicine that includes minimally-invasive heart procedures (Percutaneous Coronary Interventions) like balloon angioplasty to open blocked arteries and the placement of stents to help keep them open.  Several hundred thousand of these procedures are performed each year.  
"We wanted to know if patients who received these stents, especially during the time when new fellows are starting, had higher rates of procedural complications and higher rates of adverse outcomes," Hawkins said. 

Hawkins and his team examined a national data registry from 136 hospitals affiliated with the Accreditation Council for Graduate Medical Education and its accredited interventional cardiology fellowship programs. These hospitals performed more than 309,000 Percutaneous Coronary Interventions during the 2009-2012 study period. More than 61,000 of those PCIs were performed during the July-August time frame.

After comparing the data from those done at the time when fellows are beginning their training and those done later, Hawkins and fellow researchers discovered welcome and reassuring results.
"Essentially what we found was there was no difference in bleeding complications or death rates," he said.

Hawkins believes the consistency of outcomes is due to several factors, including more rigorous supervision of trainees during PCI procedures.

"I think it's really a win-win for everyone involved," Hawkins said. "It's good news for the public at large and for the patients we treat, and also good news for those of us who are very focused on academic medical education."
Hawkins acknowledges the study had some limitations.  For example, a fourth of the hospitals with interventional cardiology fellowships did not participate in the data registry.

The study, funded by the American College of Cardiology Foundation, is published online. It will appear in print in the Journal of the American College of Cardiology in March.  

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