Effects of night-time and weekend admissions on in-hospital mortality in acute myocardial infarction patients in Japan

Abstract

BackgroundPatients admitted to hospital during off-hours may experience poorer quality of care and clinical outcomes. However, few studies have examined the variations in clinical processes and outcomes across admission times and days of the week in acute myocardial infarction (AMI) patients. This study aimed to comparatively analyze the effect of weekend and weekday admissions stratified by admission time on in-hospital mortality in AMI patients.Methods and resultsUsing a large nationwide administrative database, we analyzed 103,908 AMI patients admitted to 639 Japanese acute care hospitals between April 2011 and March 2015. We divided patients into the following 4 groups: weekday daytime admissions, weekday night-time admissions, weekend daytime admissions, and weekend night-time admissions. A hierarchical logistic regression model was used to comparatively examine in-hospital mortality among the groups after adjusting for age, sex, ambulance use, Killip class, comorbidities, and the number of cardiologists in the admitting hospital. In addition, we also calculated and compared the adjusted odds ratios of various AMI therapies among the groups. The in-hospital mortality rate of weekend daytime admissions was higher than those admitted during other times (weekday daytime: 6.8%; weekday night-time; 6.5%, weekend daytime; 7.6%; weekend night-time: 6.6%; P < 0.001), even after adjusting for the covariates (adjusted odds ratio for weekend daytime admissions: 1.10; 95% confidence interval: 1.03–1.19). The prescription rates of guideline-based medications provided on the first day of admission were higher in night-time admissions than in daytime admissions.ConclusionsIn-hospital mortality rates were higher in AMI patients admitted during weekend daytime hours when compared with patients admitted during other times. Furthermore, patients admitted during daytime hours had lower prescription rates of guideline-based medications. Our findings indicate that weekend daytime admissions may be a potential target for improvement in the Japanese healthcare system.

Prolonged Hospital Stay is Associated with Increase Surgical Site Infection, Gastrointestinal and Hepatobiliary Surgery – A propensity Matched Analysis

“…[11] There are studies about effect of night times and weekend admission on morbidity and mortality. [12,13]. However, we could not find effect of prolonged hospital stay on over all morbidity and mortality.…”

Annexin A3 gene silencing promotes myocardial cell repair through activation of the PI3K/Akt signaling pathway in rats with acute myocardial infarction

“…AMI occurs when the blood supply to the heart is decreased (ischemia) for an extended period which acts as a chief contributor to global disease burden (Gong et al, ; Mizuno, Kunisawa, Sasaki, Fushimi, & Imanaka, ). Although the pathophysiology of AMI has been largely advanced by reperfusion and drug therapies, adverse left ventricular remodeling after AMI is still the commonest reason of heart failure (Sun, Xie, Du, Sun, & Liu, ).…”

Higher in-hospital mortality during weekend admission for acute coronary syndrome: a large-scale cross-sectional Italian study

“…Although the design of our study is unable to provide an explanation for the potential causes underlying the observed association between day of admission and mortality, we can speculate that longer time from symptom onset to diagnosis and treatment and hospital understaffing during weekend might play a role. 18 The theory of understaffing was recently questioned by two recent articles by Aldridge et al 19 and Hsu et al 20 : these authors were unable to demonstrate a correlation between weekend staffing and mortality risk in relation to the day of admission and concluded that further investigation would have been necessary before adopting a 7day service as a solution to the weekend effect.…”