[HN Gopher] Mortality patterns for patients hospitalized during ...
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Mortality patterns for patients hospitalized during cardiology
meetings (2016)
Author : impish9208
Score : 100 points
Date : 2023-08-05 14:12 UTC (8 hours ago)
(HTM) web link (www.ncbi.nlm.nih.gov)
(TXT) w3m dump (www.ncbi.nlm.nih.gov)
| brd529 wrote:
| Remember this is from 2016
| ChrisMarshallNY wrote:
| I had a friend tell me of an old doctor of his.
|
| He said his doctor (an internist) was attending a medical
| conference for allergists, in the Bahamas. About 500 doctors
| attended.
|
| This doctor was fearfully allergic to peanuts. Like, anaphylactic
| allergic.
|
| He had an anaphylactic reaction to something he ate, during the
| main speaker banquet.
|
| He died.
|
| Surrounded by 500 allergists.
| rightbyte wrote:
| The joke is to never get sick in the hospital employee
| restaurant for the ultimate bystander effect experience. Or too
| many cooks, I guess.
| lostlogin wrote:
| I saw some sort of collapse at a medical school. Loads of
| people went to help. At the time we wondered how that went,
| with half trained students on the loose.
| robertlagrant wrote:
| He paid the irony price.
| rscho wrote:
| In that situation you need an anesthesiologist, not an
| allergologist. Even a random anesthesia tech without medical
| education would do far better than an allergologist. A
| paramedic too.
| draw_down wrote:
| [dead]
| dehrmann wrote:
| Also 500 bystanders.
| tpoacher wrote:
| I mean, fair enough. Just because you're an immunologist
| doesn't mean you carry spare adrenaline, antihistamines,
| inhalers, and steroid infusions in your fanny pack at
| conventions. All they can do is call an ambulance.
|
| It's a bit like expecting a hacker to hack a network without
| their laptop.
|
| (bit weird if HE didn't have his epipen on him though ...)
| yellowapple wrote:
| > Just because you're an immunologist doesn't mean you carry
| spare adrenaline, antihistamines, inhalers, and steroid
| infusions in your fanny pack at conventions.
|
| Maybe they should.
|
| > It's a bit like expecting a hacker to hack a network
| without their laptop.
|
| A _real_ hacker can break into a network with some bubblegum,
| a pen, and a corgi.
| oaktrout wrote:
| A 2018 article by the same author with a similar theme:
| https://www.ahajournals.org/doi/10.1161/jaha.117.008230
|
| Interestingly, there were no differences in the number of
| procedures performed on meeting and nonmeeting days (it's not the
| surgeries that are killing people).
|
| The hypothesis that I find most interesting is that the
| cardiologists who are at the meetings spend less time caring for
| patients and more time doing research, hence they aren't as good
| at caring for patients.
| 13of40 wrote:
| I've never been to one of those conferences, so just a second
| hand anecdote:
|
| A couple of years ago some friends of ours invited us to lunch
| with a couple of their relatives who were in town for a
| cardiology conference. They (the relatives) were both stout*
| people, technicians of some kind rather than doctors, and the
| husband was super hung over from the previous night.
|
| Anyway, they told us all about how the sessions at these things
| were pretty dry, but the after party was always a drunken,
| hours long slurry of alcohol and aorta-clogging food, and it
| was so ludicrously un-heart-healthy that it was a running gag.
|
| So I'm wondering if the people who opt to go to those things
| tend to perform differently in their work than the ones who
| stay home and live quieter lives?
|
| (*I only mention this because a few days after we had lunch,
| the husband apparently had a heart attack while he was driving,
| pulled off to the side, and died.)
| sieste wrote:
| Could it be that the conferences take place at a time of year
| where mortality due to cardiac events is higher, e.g. in summer?
| Maybe I missed it, but I don't think they controlled for time of
| year.
| Swizec wrote:
| The author of this study talks about time of year in a later
| podcast, iirc. They did control for time of year (maybe in a
| later study) and found no effect.
|
| source: https://freakonomics.com/podcast/what-happens-to-
| patients-wh...
| thenerdhead wrote:
| Another reason why doing "something" is not always the right
| thing to do.
|
| https://en.m.wikipedia.org/wiki/Iatrogenesis
| timmaxw wrote:
| Summarizing:
|
| > In teaching hospitals, mortality was lower among high-risk
| patients with heart failure or cardiac arrest admitted during
| meeting dates (P < .001) No mortality differences existed for
| low-risk patients in teaching hospitals or high- or low-risk
| patients in nonteaching hospitals [or high-risk patients with AMI
| in teaching hospitals]
|
| So in the specific case of teaching hospitals with high-risk
| patients with heart failure or cardiac arrest, the normal
| treatment is making things worse.
|
| Outside of that special case, the cardiology meetings don't seem
| to have any effect (positive or negative). This could mean that
| the normal treatment is useless. Or it could mean that the
| hospital is doing a good job of planning around the cardiology
| meeting -- e.g. delaying non-urgent treatment until the next day,
| while ensuring there are still enough doctors on staff for the
| urgent cases.
| arpowers wrote:
| They suggest mortality is lower during meetings because:
|
| "the intensity of care provided during meeting dates is lower and
| that for high-risk patients with cardiovascular disease, the
| harms of this care may unexpectedly outweigh the benefits."
|
| Not sure if they accounted for delayed surgeries in the study.
| boringuser2 wrote:
| Honestly, I've been trying with the idea that most medicine is
| actually just straight up actively harming people in complex
| ways.
|
| Note: I said most, there are obvious exceptions.
| readthenotes1 wrote:
| Medical care mistake is possibly the 3rd leading cause of
| death in the United States...
|
| https://www.hopkinsmedicine.org/news/media/releases/study_su.
| ..
| contravariant wrote:
| Not sure if that's a useful definition of 'harm'. It's like
| pointing out that most substances are poisonous. Can't just
| ignore the dose or context when it comes to medicine.
| JHorse wrote:
| I like that framing. Personally, I've always thought of
| doctors as "professional educated guessers"
| Scoundreller wrote:
| A problem is that the inputs are so heterogenous. Hard to
| avoid "Garbage in, garbage out" in the input-process-output
| cycle.
| michaelmrose wrote:
| This is complete and utter nonsense. The "exceptions" are 99%
| of medicine. Almost all of medicine is applying strategies we
| know on average improve outcomes as well as we know how and
| as well as that clinician is able to within the scope of the
| time given. If you don't know this is likely that you haven't
| had much need of medicine. I you had you would know better.
|
| This isn't to say outcomes are always good our knowledge is
| imperfect, people are imperfect, and not every situation has
| a good answer.
| boringuser2 wrote:
| 1. You're pre-supposing that intervention in these cases is
| both common enough to affect things on a sociological
| level, and necessary enough to also contribute to the
| effect.
|
| I suspect given that the rarity of many serious ailments
| until much later in life simply no intervention would
| suffice in any reasonable epidemiological sense.
|
| 2. Your hypothesis presupposes that serious medical care is
| commonly necessary enough to significantly improve public
| health.
|
| I know of young people that have been harmed by medical
| science, and not many come to mind whom I would consider
| having been in absolute need of medical intervention.
|
| Given that medicine often harms patients demonstrably, with
| mistakes and opiates contributing majorly to human
| fatalities, it occurs to me that I can more commonly
| produce anecdotes where medication or medicine harmed
| rather than helped where it would have been absolutely
| necessary.
| robwwilliams wrote:
| Emphasis--"on average" and yet often applied deep into both
| tails of unknown distributions.
|
| "Complete and utter nonsense" also ignores many
| inconvenient truths about medical care today and of course
| in the not-so-distant past. Medical history should temper
| the tone.
| michaelmrose wrote:
| > I've been trying with the idea that most medicine is
| actually just straight up actively harming people in
| complex ways.
|
| This says that most medicine is harmful full stop. This
| is conspiracy theory thinking. It is not far off from
| I've been thinking maybe the earth really is flat.
|
| Most medicine is setting broken legs, dispensing
| antibiotics for infections, prescribing insulin for
| diabetes. In other words interventions that are
| straightforwardly positive. It is only when the situation
| is already dire and outcomes are already poor that
| intervention is sometimes negative and even then we are
| often discussing whether an intervention at 72 resulted
| in the person dying then instead of 74 wherein the person
| would have died thrice over between 60 and 72 and been
| crippled between.
|
| Yes I too read about both the era where we thought bad
| smells caused disease and disdained hand washing AND
| modern end of life care which is oft pointless this
| doesn't mean medicine is mostly harmful. Words have
| meanings and the posters are nonsense as you know.
| contravariant wrote:
| Alternatively people who suffered acute heart conditions while
| a cardiologist was not available were simply not hospitalized,
| they're dead.
| jprete wrote:
| What mechanism do you think might cause that connection?
| IG_Semmelweiss wrote:
| To understand why, i think you have to know 2 data points
|
| 1) The first date (and then-current surgery schedule) at the
| point when the conference dates where announced.
|
| 2) The date (and then-current surgery schedule) at the point,
| when the doctor booked his/her travel plans.
|
| Both lists and dates will help you understand if changes in
| information also resulted in the changes of mortality (by
| rescheduling hard cases to a later date, for example).
| mankyd wrote:
| > Not sure if they accounted for delayed surgeries in the
| study.
|
| That's sort of what I am wondering. Perhaps it just delays the
| inevitable - the patient is gravely ill is is going to die if
| they don't perform _potentially_ life-saving surgery. The
| surgery, is of course risky.
|
| The conference delays the surgery, so the patient's surgery or
| other high risk procedures are delayed. This gives the patient
| a few more days of being ill, but doesn't probabilistically
| change the outcome of actually undergoing the procedure.
| MattRix wrote:
| They appear to be already accounting for that since they are
| measuring 30-day mortality for acute conditions. They're
| saying it's possible the reduced mortality is due to the high
| risk procedures actually being unnecessary.
| prepend wrote:
| But they don't account for patients going to other
| hospitals and dying there instead.
| yellowapple wrote:
| Now I'm curious about mortality rates in the weeks
| following a conference. "Lemme try this neat trick I
| learned..."
| oaktrout wrote:
| As an argument to illustrate why 30 day mortality isnt a
| long enough period, imagine this scenario: you have a
| cancer that has a 90% chance of killing you in one year.
| You will be cured if you get the surgery tomorrow, but the
| surgery has a 30% mortality rate. In one month, 30% or
| those who got the surgery will die, where all those who
| didn't get the surgery will still be alive. In one year,
| 70% of those who got the surgery live, whereas only 10% who
| didn't get the surgery are alive.
| Swizec wrote:
| > The conference delays the surgery, so the patient's surgery
| or other high risk procedures are delayed.
|
| My understanding from listening to the author's podcast, is
| that this is the proposed mechanism. There is a percentage of
| patients who were going to get better on their own anyway.
| But if they receive urgent care, it may cause harm.
|
| The conclusion seems to be that there is a measurable
| percentage of patients who got surgery but didn't need it and
| thus suffered greater harm than if they had been left alone.
| Because heart attacks are so critical, medical staff errs on
| the side of action instead of waiting. This seems reasonable,
| but may in fact be bad.
|
| it's a good podcast: https://freakonomics.com/podcast/what-
| happens-to-patients-wh...
| Detrytus wrote:
| Delayed surgeries are precisely what they mean by "lower
| intensity of care".
| curiousObject wrote:
| _High-risk patients with heart failure and cardiac arrest
| hospitalized in teaching hospitals had lower 30-day mortality
| when admitted during dates of national cardiology meetings._
|
| A rare case of meetings proving beneficial? But why?
| Knee_Pain wrote:
| Who knows. Maybe all the old doctors are gone for the meetings
| and only the young ones with more up to date knowledge are left
| to treat patients?
|
| To even suggest a causal link we would need soooo much data
| that nobody has right now
| Detrytus wrote:
| I would say that doctors who attend conferences have more up
| to date knowledge than those who don't, regardless of age.
| dmitrij wrote:
| Sometimes when the boss is away the team works better. At
| least, that is the case with my team. I don't really know why.
| Because I really think I am not a bad boss. But apparently
| either I am or they just don't need one and I am in the end a
| distraction.
| rafapras wrote:
| Maybe coordination costs are lower when the boss is away? So
| more time is spent focusing on the task in the short term.
| And consequences would show up latter? When my boss went on
| maternity leave , the first 2 months were a breeze then
| things started getting harder.
| analog31 wrote:
| It would be worth looking into the seniority of the doctors
| attending the meetings. This is purely anecdotal, but my town
| hosts some meetings and conventions, including doctors, and
| I've been hired by those events as a musician.
|
| I'm always struck by how young the attendees are. They look
| like _kids_. It may be that meetings are more of an attraction
| for people trying to build their careers, make connections, and
| have a free vacation, whereas the senior doctors are happy to
| stay at home and man the fort, plus they have the usual
| obligations of older workers, such as families.
|
| This is also the case at my techie day job: Most of the
| interest in attending meetings is among the junior engineers.
| malaya_zemlya wrote:
| My guess, they delay risky procedures until senior doctors get
| back from the conference
| MattRix wrote:
| This is not it, they were measuring 30-day mortality, not
| just mortality during the exact days of the conference.
| JamisonM wrote:
| Even with 30-day mortality this can be the case, heart
| patients I am sure do survive risky procedures and die two
| weeks later because of complications due to the procedure
| fairly regularly. (Not that I have an opinion on the root
| cause here.)
| Scoundreller wrote:
| I completely misunderstood the headline and thought it was about
| people/patients at the meetings themselves that got hospitalized.
|
| What happens when you have an acute cardiac issue surrounded by
| hundreds of cardiologists?
| tough wrote:
| There's a similar effect in place due to most operations being
| monday 9am not on weekends, so a lot of more people die during
| those skewing stats
| karl_gluck wrote:
| Wow, the exact opposite of what I might have guessed from the
| title.
|
| Does this mean percutaneous coronary intervention [PCI] is over-
| applied, or something else?
| Enginerrrd wrote:
| Hard to say without more details, though it's certainly
| plausible.
|
| There's other possibilities though. Like if the timing of other
| interventions is being delayed until the cardiologist is able
| to see the patient instead of deferring to a less specialized
| physician.
| k__ wrote:
| So, it's better that a random physician does something now
| than waiting for a cardiologist doing the best thing too
| late?
| Enginerrrd wrote:
| No, not necessarily. There's no indication of that
| whatsoever. The point was just that there's insufficient
| information to conclude much of anything about why this was
| observed. It could also be that PCI is over applied leading
| to increased mortality.
| JHorse wrote:
| Could it just be that doctors who attend these meetings are
| more career (and less patient) focused than their compatriots?
| brobdingnagians wrote:
| If I'm not mistaken, I think attendance at conferences is
| sometimes required as hours to keep up to date in medical
| practice. Not sure though.
| chapium wrote:
| Risky procedures likely scheduled around when the cardiologist
| is available
| herodotus wrote:
| It has been speculated for some time that fewer patients die when
| hospitals are on strike. See for example:
| https://www.psychologytoday.com/ca/blog/slightly-blighty/201...
| tmpz22 wrote:
| As someone dealing with elder care of multiple family members I
| also believe mental anguish caused by medical environments,
| including insurance and billing in the US, and the
| dismissiveness of hospice care (you're taking too long to die,
| speed it up or transition to a lower form of care) doesn't help
| the matter.
|
| Modern medicine is a miracle but struggles to evolve beyond
| many immediate hurdles. In an extreme minority of cases it can
| be better to avoid traditional intake methods.
| ozSofi wrote:
| When people die during a surgery they die immidiately, but when
| their lives get extended after a surgery, it only happens years
| later.
| beebmam wrote:
| Speaking as someone with a health care worker in the family who
| just went on strike, I think this makes a lot of sense. When
| hospital workers go on strike, it often forces the hospital to
| go on diversion, leading to other hospitals taking on all new
| patients, who are usually in some form of medical crisis and
| have a higher chance of dying than stabilized patients already
| under care. Thus, it makes sense that a hospital which has
| workers that go on strike have a lower death rate on average.
| somenameforme wrote:
| The article mentions controlling for this in numerous ways.
| It was looking at elective surgeries, as well as county wide
| mortality rates and not just a single hospital. That said, in
| the elective surgery cases it could well be a spin on what
| you're mentioning and people just deferred their surgeries
| until after the strike. You'd think _surely_ they also
| controlled for this, though.
| lostlogin wrote:
| Where I am, diversion wouldn't help. The system is
| nationalised so all the hospitals would strike.
| mhb wrote:
| Comment from Marginal Revolution by someone who sounds
| knowledgeable:
|
| "To start with there is a significant problem with the article.
| Cardiac surgeons don't go to cardiology meetings and don't
| perform the type of interventions mentioned in the article.
| Interventional cardiologists are not cardiac surgeons. The
| recurrent mislabeling of the specialty involved is yet another
| example of the slipshod treatment and lack of understanding of
| science and medicine in the lay press which makes for an ill-
| informed public."
|
| https://marginalrevolution.com/marginalrevolution/2023/08/86...
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