Mortality differences in acute myocardial infarction patients in the Netherlands: The weekend-effect

Eindhoven, D.C.; Wu, Hoi W.; Kremer, Stijn; Erkelens, Judith A van; Cannegieter, Suzanne C.; Schalij, Martin J.; Borleffs, C. Jan Willem

doi:10.1016/j.ahj.2018.07.015

Cited by 20 publications

(26 citation statements)

References 33 publications

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“…In calendar weeks 15–16, the emergency department visit volume graphs of 2019 and 2020 get closer, which may have several reasons like behavior and travelling attitudes. Exemplarily, Christmas and Midsummer holidays have been associated with higher risk of myocardial infarction; a weekend-effect with delay in coronary angiography for NSTEMI resulting in a higher mortality has been described [ 12 , 13 ]. Behavior during the Easter holidays may have been different in 2020 due to the government restrictions in Germany.…”

Section: Discussionmentioning

confidence: 99%

Decline of emergency admissions for cardiovascular and cerebrovascular events after the outbreak of COVID-19

et al. 2020

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Background The spread of the novel coronavirus SARS-CoV-2 and the guidance from authorities for social distancing and media reporting lead to significant uncertainty in Germany. Concerns have been expressed regarding the underdiagnosing of harmful diseases. We explored the rates of emergency presentations for acute coronary syndrome (ACS) and acute cerebrovascular events (ACVE) before and after spread of SARS-CoV-2. Methods We analyzed all-cause visits at a tertiary university emergency department and admissions for ACS and ACVE before (calendar weeks 1–9, 2020) and after (calendar weeks 10–16, 2020) the first coronavirus disease (COVID-19) case in the region of the Saarland, Germany. The data were compared with the same period of the previous year. Results In 2020 an average of 346 patients per week presented at the emergency department whereas in 2019 an average of 400 patients presented up to calendar week 16 ( p = 0.018; whole year 2019 = 395 patients per week). After the first COVID-19 diagnosis in the region, emergency department visit volume decreased by 30% compared with the same period in 2019 ( p = 0.0012). Admissions due to ACS decreased by 41% ( p = 0.0023 for all; Δ − 71% ( p = 0.007) for unstable angina, Δ − 25% ( p = 0.42) for myocardial infarction with ST-elevation and Δ − 17% ( p = 0.28) without ST-elevation) compared with the same period in 2019 and decreased from 142 patients in calendar weeks 1–9 to 62 patients in calendar weeks 10–16. ACVE decreased numerically by 20% [ p = 0.25 for all; transient ischemic attack: Δ − 32% ( p = 0.18), ischemic stroke: Δ − 23% ( p = 0.48), intracerebral haemorrhage: Δ + 57% ( p = 0.4)]. There was no significant change in ACVE per week ( p = 0.7) comparing calendar weeks 1–9 (213 patients) and weeks 10–16 (147 patients). Testing of 3756 samples was performed to detect 58 SARS-CoV-2 positive patients (prevalence 1,54%, thereof one patient with myocardial and two with cerebral ischemia) up to calendar week 16 in 2020. Conclusions The COVID-19 pandemic was associated with a significant decrease in all-cause admission and admissions due to cardiovascular events in the emergency department. Regarding acute cerebrovascular events there was a numerical decrease but no significant difference.

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Section: Discussionmentioning

confidence: 99%

Decline of emergency admissions for cardiovascular and cerebrovascular events after the outbreak of COVID-19

et al. 2020

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“…10,11 Studies of the AMI population reported significantly lower utilization of revascularization strategies and increased time to intervention on the weekends compared with weekday admissions. 8,9 These factors, along with lower rates of staffing, were attributed to the higher mortality seen in weekend admissions. 8,9 Large studies from national registries also found significantly higher mortality in weekend STEMI admissions compared with admissions during regular hours.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 Large studies from national registries also found significantly higher mortality in weekend STEMI admissions compared with admissions during regular hours. 7,9 However, these differences were attenuated after adjustment for time to reperfusion and utilization of invasive procedures. 7 A meta-analysis of studies reporting outcome differences based on time of admission until 2013 also reported higher mortality among patients with AMI admitted during off-hours.…”

Section: Discussionmentioning

confidence: 99%

Weekend Effect in the Management and Outcomes of Acute Myocardial Infarction in the United States, 2000-2016

Vallabhajosyula

Patlolla

Miller

et al. 2020

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Objective: To assess the effects of weekend admission vs weekday admission on the management and outcomes of acute myocardial infarction (AMI). Methods: Adult ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) hospital admissions were identified using the National (Nationwide) Inpatient Sample (2000-2016). Interhospital transfers were excluded. Timing of coronary angiography (CA) and percutaneous coronary intervention (PCI) relative to the day of admission was identified. Outcomes of interest included in-hospital mortality, receipt of early CA, timing of CA and PCI, resource utilization, and discharge disposition for weekend vs weekday admissions. Results: Of the 9,041,819 AMI admissions, 2,406,876 (26.6%) occurred on weekends. Compared with 2000, in 2016 there was an increase in weekend STEMI (adjusted odds ratio [aOR], 1.12; 95% CI, 1.08-1.16; P<.001) but not NSTEMI (aOR, 1.01; 95% CI, 0.98-1.02; P¼.21) admissions. Compared with weekday admissions, weekend admissions received comparable CA (59.9% vs 58.8%) and PCI (38.4% vs 37.6%) and specifically lower rates of early CA (hospital day 0) (26.0% vs 20.8%; P<.001). There was a steady increase in CA and PCI use during the 17-year period. Mean AE SD time to CA was higher in the weekend group vs the weekday group (1.2AE1.8 vs 1.0AE1.8 days; P<.001). Weekend admission did not influence in-hospital mortality (aOR, 1.01; 95% CI, 1.00-1.01; P¼.05) but had fewer discharges to home (58.7% vs 59.7%; P<.001). Conclusion: Despite small differences in CA and PCI, there were no differences in in-hospital mortality of AMI admissions on weekdays vs weekends in the United States in the contemporary era.

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“…In calendar weeks 15 and 16, the emergency department visit volume graphs of 2019 and 2020 get closer, which may have several reasons like behavior and travelling attitudes. Exemplarily, Christmas and Midsummer holidays have been associated with higher risk of myocardial infarction; a weekend-effect with delay in coronary angiography for NSTEMI resulting in a higher mortality has been described [11,12]. Behavior during the Easter holidays may have been different in 2020 due to the government restrictions in Germany.…”

Section: Discussionmentioning

confidence: 99%

Decline of emergency admissions for cardiovascular and cerebrovascular events after the outbreak of COVID-19

Schwarz

Mahfoud

Lauder

et al. 2020

Preprint

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Background The spread of the novel coronavirus SARS-CoV-2 and the guidance from authorities for social distancing and media reporting lead to significant uncertainty in Germany. As concerns have been expressed regarding the underdiagnosing of harmful diseases. We explored the rates of emergency presentations for acute coronary syndrome (ACS) and acute cerebrovascular events (ACVE) before and after spread of SARS-CoV-2. Methods We analyzed all-cause visits at a tertiary university emergency department and admissions for ACS and ACVE before (calendar weeks 1 to 9, 2020) and after (calendar weeks 10 to 16, 2020) the first coronavirus disease (COVID-19) case in the region of the Saarland, Germany. The data were compared with the same period of the previous year. Results In 2020 an average of 346 patients per week presented at the emergency department whereas in 2019 an average of 400 patients presented up to calendar week 16 (p=0.018; whole year 2019 = 395 patients per week). After the first COVID-19 diagnosis in the region, emergency department visit volume decreased by 30% compared with the same period in 2019 (p=0.0012). Admissions due to ACS decreased by 41% (p=0.0023 for all; Δ -71% (p=0.007) for unstable angina, Δ -25% (p=0.42) for myocardial infarction with ST-elevation and Δ -17% (p=0.28) without ST-elevation) compared with the same period in 2019 and decreased from 142 patients in calendar weeks 1 to 9 to 62 patients in calendar weeks 10 to 16. ACVE decreased numerically by 20% (p=0.25 for all; transient ischemic attack: Δ -32% (p=0.18), ischemic stroke: Δ -23% (p=0.48), intracerebral haemorrhage: Δ +57% (p=0.4)). There was no significant change in ACVE per week (p=0.7) comparing calendar weeks 1 to 9 (213 patients) and weeks 10 to 16 (147 patients). Testing of 3756 samples was performed to detect 58 SARS-CoV-2 positive patients (prevalence 1,54%, thereof one patient with myocardial and two with cerebral ischemia) up to calendar week 16 in 2020. Conclusions The COVID-19 pandemic was associated with a significant decrease in all-cause admission and admissions due to cardiovascular events in the emergency department. Regarding acute cerebrovascular events there was a numerical decrease but no significant difference.

show abstract

Mortality differences in acute myocardial infarction patients in the Netherlands: The weekend-effect

Cited by 20 publications

References 33 publications

Decline of emergency admissions for cardiovascular and cerebrovascular events after the outbreak of COVID-19

Decline of emergency admissions for cardiovascular and cerebrovascular events after the outbreak of COVID-19

Weekend Effect in the Management and Outcomes of Acute Myocardial Infarction in the United States, 2000-2016

Decline of emergency admissions for cardiovascular and cerebrovascular events after the outbreak of COVID-19

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