Comparison of In-Hospital Mortality for Acute Myocardial Infarction in Switzerland With Admission During Routine Duty Hours Versus Admission During Out of Hours (Insight Into the AMIS Plus Registry)

Effect of weekend admission for acute myocardial infarction on in-hospital mortality: A retrospective cohort study

“…The effect of off-hour admission for AMI on mortality has been controversial because previous studies have shown inconsistent results [1,[3][4][5][9][10][11][12][13][14][15]. Recently, a study using data from an administrative database in New Jersey reported that 30-day mortality for AMI was higher in patients admitted on weekends than on weekdays [10].…”

“…Hospitals generally provide comprehensive care on weekdays but have decreased staffing levels on weekends, with possible reductions in the quality of care [4][5][6]. The differences in the level of care between weekdays and weekends may cause 'weekend effect' in several diseases [1][2][3].…”

“…The management of acute myocardial infarction (AMI) generally requires emergency invasive cardiac procedures, such as percutaneous coronary intervention (PCI) [7,8], which are often less available during off-hours (weekends and nights) than during regular hours because of limited staff availability [4,5,9]. The effect of off-hour admission for AMI on mortality has been controversial because previous studies have shown inconsistent results [1,[3][4][5][9][10][11][12][13][14][15].…”

Finding the Real Culprit Between Circadian Rhythm and “Out of Hours Effect” to Explain the Higher Myocardial Infarction Size Among Patients With Symptom Onset Occurring at Night

“…During the night (when medical team size is usually smaller), different mean procedure times, different mean thrombolysis in myocardial infarction scores at the end of the procedures, or different mean numbers and sizes of used stents could cause an important bias because of an "out of hours effects." In fact, previous publications have already shown a poorer prognosis for people undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction during the night, 3,4 and this article does not enable differentiation between higher cardiomyocyte vulnerability to ischemia at this time of the day and a lower performance of the medical team, both of which could explain higher creatine kinase levels. Similarly, authors could have studied the variations of creatine kinase levels depending on hours of symptom onset, taking into account weekends only 5 (out of hours system at every hour of the day during a weekend).…”

Accelerated care versus standard care among patients with hip fracture: the HIP ATTACK pilot trial

“…We modelled this strategy on the approach undertaken with percutaneous coronary intervention (PCI) among patients with acute ST elevation myocardial infarction (i.e., PCI was first established as effective during daytime working hours and then subsequently established after hours). 22 We excluded patients who required emergent surgery (e.g., subdural hematoma), had an open hip fracture or were previously enrolled in the trial.…”