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

Abstract

Aims An increased mortality risk during weekend hospital admission has been consistently observed. In the present study, we evaluated whether the current improvement in management of acute coronary syndromes (ACS) has reduced this phenomenon. Methods and results We extracted data from the Italian National Healthcare System Databank of 80 391 ACS admission in the region of Lombardia between 2010 and 2014. ICD-9 codes were used to assess the diagnosis. We performed a multiple logistic regression analysis to compare the mortality rates between weekend and weekday admissions. Mean age of the study population was 67.6 years, 30.1% of patients were women. ST segment elevation myocardial infarction (STEMI) accounts for 42.2% of admissions. The total in-hospital mortality was 3.05% and was positively predicted by weekend admission [odds ratio (OR) 1.13, P U 0.006), age and female sex. The weekend effect on mortality was only significant for STEMI (OR 1.11, P U 0.04) in comparison to non-STEMI (NSTEMI) or unstable angina. The trend of the risk of death was found to be negatively correlated with age: the risk of death was significantly higher in all age clusters younger than 75 (OR 1.22, P < 0.01) and even greater in the very young subgroup under 45 years of age (OR 2.09, P U 0.03). Conclusion Our data indicate that increased mortality risk is still present during weekend admissions. This phenomenon is particularly evident in younger patients and in individuals admitted for STEMI.

Higher 1‐year mortality on rest days in patients with acute coronary syndromes and decompensated heart failure—A SPUM‐ACS sub‐study

“…Previous literature reported conflicting results when comparing the outcomes of patients presenting with AMI on workdays with patients on rest days. Several studies have found higher mortality rates for patients admitted on rest days, 10–19 while others showed no differences 20–22 . A large meta‐analysis by Kwok et al 11 of over 14 million patients found a mild increase in early mortality for patients admitted with AMI on rest days.…”

“…However, conflicting data exist upon whether the outcome of ACS patients differs for admissions on work or on rest days 10–22 . While a rest day effect entailing higher mortality has been proposed by several studies, 10–19 others did not observe any difference in clinical outcome between workday and rest day presentations 20–22 . Moreover, most studies focused on short‐term mortality rates, only a few reported long‐term data 10,19,20 …”

Application of Modern Clinical Risk Scores in the Global Assessment of Risks Related to the Diagnosis and Treatment of Acute Coronary Syndromes in Everyday Medical Practice

“…It is not about time delays during the infarction treatment procedure, the effect of which on the effectiveness of treatment is well described [87], but about improper organization of the workplace, the impact of the time of day or night, day of the week (weekday, weekend, holiday day) in which the patient is admitted to the hospital (or undergoing invasive procedure), or finally due to the experience of the staff or their workload on a given day. In the literature, there are only individual reports on the importance of these issues for the final results of treatment in a patient with MI [88]. Additionally worth mentioning is the phenomenon of "treatment risk paradox" consisting in the unintentional less aggressive treatment of high-risk patients.…”

Contemporary NSTEMI management: the role of the hospitalist

“…The former are less likely to undergo interventional procedures or to be placed on evidence-based anti-platelet therapy. Of note, women are more likely to have a Type 2 versus a Type 1 MI [4]. Care is often focused on stabilizing the presenting illness that cardiac sequelae and their management may be deprioritized, or their underlying illness presents contraindications to usual cardiac management.…”