Mortality rate doubles with weekend vs. weekday admission for patients with ACS, HF
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Key takeaways:
- Adults with ACS and acute decompensated HF have a higher 1-year mortality risk when admitted on weekends vs. weekdays.
- There were no between-group differences for 30-day or in-hospital mortality.
Adults with ACS and acute decompensated HF are twice as likely to die of any cause within 1 year if admitted on weekends or holidays vs. weekdays, independent of age or hemodynamic status or traditional CV risk factors, researchers reported.
“The observation of a rest-day effect has been previously attributed to various factors, including inferior staffing, delayed access to diagnostic and therapeutic procedures, as well as a potential selection bias of more severely ill patients on rest days,” Michael A. Matter, of the department of cardiology at University Hospital Zurich, and colleagues wrote in Catheterization and Cardiovascular Interventions. “Despite ACS patients presenting with acute decompensated HF being a high‐risk patient population and thus warranting special attention, there is only little data concerning a potential rest-day effect on mortality within this patient subgroup.”
Data were derived from Matter MA, et al. Catheter Cardiovasc Interv. 2023;doi:10.1002/ccd.30938.
Matter and colleagues analyzed data from 4,787 patients with ACS enrolled in the prospective Special Program University Medicine Acute Coronary Syndromes and Inflammation (SPUM‐ACS) study, a cohort of patients presenting with ACS within 5 days of symptom onset. The cohort included patients who underwent coronary angiography from 2009 to 2017.
Researchers divided patients into two groups according to time of coronary catheterization on workdays, defined as Monday through Friday (74.9%), or rest days, defined as Saturdays, Sundays and public holidays (25.1%). Researchers followed patients for 1 year.
Within the cohort, 4.3% of patients presented with acute decompensated HF. Baseline medications and medication at discharge were similar between groups, as was the median GRACE 2.0 ACS risk calculator. Predicted 1-year all-cause mortality risk via GRACE 2.0 score was also similar for both groups.
Patients with ACS and acute decompensated HF were twice as likely to die within 1 year of follow-up when admitted on weekends vs. weekdays (34.6% vs. 17.4%; P = .009). After correction for baseline characteristics, including the GRACE 2.0 score, weekend or holiday presentation remained a predictor for 1‐year mortality, with an adjusted HR of 2.42 (95% CI, 1.14-5.17; P = .022). There were no between-group differences for 30-day and in-hospital all-cause mortality. For patients with ACS but without acute decompensated HF, there were no mortality differences between the rest-days group and the workdays group.
“Rest-day presentation remained a strong independent predictor for 1‐year all‐cause mortality after adjustment for key baseline characteristics, including the GRACE 2.0 score,” the researchers wrote. “Thus, the high‐risk population of ACS patients presenting with acute decompensated HF deserves intensified attention, both clinically and in terms of future research. Subsequent studies should further explore potential triggers and drivers behind the higher mortality in ACS patients with acute decompensated HF presenting on rest days.”
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