Long Waits for Cardiac Surgery Associated With Readmission and Death

	June 4, 1999 - A pair of reports and editorials in the June issue of 
Heart drive home the same conclusion: waiting for heart surgery can be lethal
and the longer the wait, the greater the risk of death.
	In the first paper, Dr. M. Seddon of Green Lane Hospital in Auckland
reports that the New Zealand government's attempt to prioritize the waiting
list for bypass surgery is not reducing mortality and complications. Dr.
Seddon's team explain that since May 1996, patients waiting for bypass surgery
have been assigned points for certain variables, and patients must accumulate 35
points in order to be put on the waiting list. The team reviewed records for 701
outpatients who were referred for bypass surgery between 1/1/93 and 1/31/96.
	The average waiting time for these patients was 146 days, and 193 waited for
more than a year. Among 65 patients who were still waiting as of 1/31/97, the average
wait was 721 days. The average waiting time for those with left main stenosis was
63 days. Total mortality on the outpatient list was 2.6%. "A high proportion (19%)
of patients waiting at home were readmitted, the majority (76%) with unstable angina,
and 12% with heart attack," the authors write.
	Separately, Dr. J. Plomp, of the University of Amsterdam reviewed deaths
among patients who were waiting for various types of heart surgery. Using 1994 and
1995 data from 11 heart surgery centers in the Netherlands, the team identified
181 deaths among patients on a waiting list. The average time on the waiting list
was 35 days. Most patients who died (86%) experienced sudden death without
showing symptoms.
	The investigators note that 54% of the deaths occurred during the first 6
weeks that patients were on the waiting lists, which is the recommended waiting time
in the Netherlands. "Consequently, sticking to this suggested guideline would avoid
only half of the waiting list deaths," they remark.
	In an editorial, British doctor Ben Bridgewater wonders whether patients
placed on a waiting list for heart surgery should be advised of the risk of waiting.
He notes that, according to the study findings, the risk associated with waiting is
as high as the risk of the surgery itself.

Heart 1999;81:563,564,586-592,593-597