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ACS admission on weekend linked to higher mortality
In patients with ACS, hospital admission on the weekend is associated with higher mortality and lower use of invasive cardiac procedures, according to a recent report.
Patients undergoing invasive procedures demonstrated higher mortality rates compared with patients with ACS admitted on weekdays, researchers reported.
11-year data on 13,988,772 patients with ACS enrolled in the Nationwide Inpatient Sample (NIS) database. Eligible patients aged at least 18 years (mean age, 65 years) were admitted to the hospital with a primary diagnosis code of ACS and had a hospital stay of less than 7 days.
Participants were further stratified by the category of their ACS: STEMI or non–ST-elevation ACS (NSTEACS). The researchers used the NIS definition of weekend admissions, which included those occurring between midnight Saturday and 11:59 p.m. Sunday. All other admissions were deemed weekday admissions.
The researchers evaluated patient-level demographics, primary payer status and individual comorbidities for all patients identified for inclusion. The primary outcome was in-hospital mortality among weekend-admission ACS patients vs. those admitted on weekdays. Additionally, the researchers evaluated differences in procedural utilization and hospital length of stay between weekday and weekend ACS admissions. Lastly, the researchers investigated differences in the utilization of coronary revascularization/intervention therapy in patients with ACS admitted on a weekday vs. weekend admissions. The researchers identified associations between weekend admission and decreased use of procedural interventions and subsequent increases in complications.
ORs were 1.04 (95% CI, 1.03-1.05) for patients with STEMI admitted on the weekend and 1.43 (95% CI, 1.42-1.44) for weekend admissions with NSTEACS. After adjustment, there remained a mortality increase in weekend admissions (OR for patients with STEMI = 1.03; 95% CI, 1.01-1.04; OR for patients with NSTEACS = 1.15; 95% CI, 1.14-1.16).
Moreover, there was a significantly lower likelihood of weekend-admitted patients to undergo coronary revascularization intervention/therapy on the first day of hospitalization (OR for patients with STEMI = 0.97; 95% CI, 0.96-0.98; OR for patients with NSTEACS = 0.75; 95% CI, 0.75-0.75).
Among patients who underwent PCI, weekend-admitted patients had greater odds for in-hospital mortality (adjusted OR for patients with STEMI = 1.09; 95% CI, 1.08-1.09; adjusted OR for patients with NSTEACS = 1.38; 95% CI, 1.29-1.47).
Using nationally representative data, we have shown that in-hospital mortality of patients with the principal diagnosis of NSTEACS was significantly higher if patients were admitted on a weekend compared to a weekday,” the researchers wrote. “Our findings can help individual physicians, hospitals and policymakers to be aware and more considerate of an approximate 15% increased likelihood mortality for those NSTEACS patients admitted during the weekend regardless of the cause.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.