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Hospital Malpractice – Heart Attack In The Hospital Setting – Often Mismanaged

Steven E. North, Esq.
Jason Persaud, Paralegal

A heart attack in a hospital is an invitation to a medical malpractice suit.

A heart attack, also known as a myocardial infarction, occurs when there is a sudden blockage in the flow of oxygen-rich blood to muscles of the heart. Disruptions may be caused by fat or cholesterol build-up on the lining of the arteries leading to the heart. Without the required oxygen necessary for the survival of the heart muscle, the organ begins to die. The cascading effect of this process is that the weakened heart cannot deliver an adequate supply of blood to vital organs such as the brain and kidneys and those organs then become impaired. Depending on the severity of the attack, the heart may heal in a few weeks or may be permanently damaged or, the patient may die.

Heart attacks are emergencies that when timely addressed can often be treated successfully to minimize and avoid damage. Treatments such as a timely stent placement or the prompt administration of clot-dissolving medications are often used to restore normal blood flow to the heart.

Ironically, according to recent studies, when heart attacks occur outside of a hospital setting they are often treated more successfully than when they occur inside a hospital. One study found that treatment for heart attacks that occur in the hospital, when the patient is being treated for another illness is less successful that when encountered as an outpatient. "The Hospital Is No Place for a Heart Attack" published in The Wall Street Journal on February 2, 2015 discusses this topic. The article notes that studies have suggested that "those patients who suffer a heart attack while already in the hospital are three times more likely to die before getting discharged as people who arrive at the emergency room after having a heart attack elsewhere."

The article does however point out that patients who are in the hospital are typically sicker and their heart attacks are often harder to recognize than those presenting to the emergency room with classic symptoms such as shortness of breath and chest pain. These classic symptoms experienced by patients already in the hospital may be wrongly attributed to the condition that they are primarily being hospitalized for which may be unrelated to heart disease. Furthermore, patients being treated for non-cardiac illnesses may be sedated or on medications that mask the classic symptoms of a heart attack. The additional testing and work-up required to diagnose an inpatient heart attack may contribute to the longer "electrocardiogram to intervention" times resulting in a worse outcome for these patients.

The hospital staff can be "blind-sided" by a heart attack that occurs when a patient is being treated for an unrelated condition. The physicians may not be focused on a patient's cardiovascular symptoms resulting in a delay in treatment and a worse prognosis.

When a patient suffers a heart attack out of a hospital, a protocol is followed to immediately address the emergency. An electrocardiogram is promptly administered to confirm the heart attack. Ideally, these patients are then immediately transported to a cardiac catheterization lab. Once in the lab, percutaneous coronary intervention, commonly referred to as PCI or angioplasty, is performed and involves non-surgically opening the narrowed or blocked arteries that caused the heart attack. Under radiology guidance, a thin and flexible tube is inserted through the skin and into the vessels to unblock the target vessels. Once the blockage is cleared, blood flow to the heart resumes which mitigates the injury to the heart. Cardiac catheterization labs are not available in all facilities or may not have 24 hour access. In the event that cardiac catheterization is unavailable, clot-dissolving drugs may be administered in an attempt to reopen clogged arteries.

The Wall Street Journal article makes reference to a study performed at the McAllister Heart Institute at the University of North Carolina School of Medicine. The study, published in 2013, compared the prognosis of patients who suffer acute ST-elevation myocardial infarctions (STEMI)* outside of the hospital with those suffered by persons who were patients in the hospital. The study concluded that patients who developed a STEMI while in the hospital experience longer "electrocardiogram to intervention" wait times and were less like to survive than those who experienced an outpatient STEMI. This study noted however that most of the inpatient individuals were older than the outpatients who presented to the emergency room which may contribute to the poorer outcomes in the hospital.

The article makes reference to yet another study, performed at the University of North Carolina School of Medicine, which followed more than 62,000 STEMI patients at hundreds of hospitals in California. The study concluded that patients who suffered a STEMI heart attack while in the hospital for another illness are more likely to die than patients who had the same type of heart attack outside of the hospital. This study noted that the inpatients were not only older, but have more co-morbidities such as lung and kidney diseases, which may have contributed to the higher mortality rates of the inpatient STEMI patients. Though, as in the previous study, they found that there was a delay in diagnosing the STEMI of the inpatient population.

The Wall Street Journal article noted that cardiologists at the University of North Carolina have now developed protocols to address the issue. The protocols are aimed at reducing the time of recognition and treatment for inpatient heart attack patients. The protocols include educating nurses to recognize possible heart-attack symptoms, making sure that an electrocardiogram is ordered immediately and that a response team is promptly mobilized to transport the patient to the catheterization lab upon confirmation by the electrocardiogram. This plan is similar to the heart attack protocol that is commonly followed in emergency rooms which are designed to recognize and treat the condition as soon as possible.

A heart attack can occur anywhere. It would seem that the best place for such a medical emergency to happen would be in a hospital and yet that may not be the case. An inordinate delay in diagnosing any condition, particularly a heart attack, which is very time sensitive for a good prognosis, can result in serious irreversible damage which forms the basis for a substantial medical malpractice claim.

*An ST-elevation myocardial infarction, commonly referred to as a STEMI, is a specific type of heart attack where there is a prolonged blockage of blood supply to the heart. "ST" refers to a specific segment of the heart's beating cycle, which will appear elevated on an electrocardiogram reading.

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