Key result
Weekend ACS admission is linked to ~37% lower in-hospital mortality versus weekday admission.
Why the study?
Acute coronary syndrome requires urgent procedures that may not be uniformly available throughout the week, potentially affecting clinical outcomes by admission day.
Does weekend admission affect in-hospital mortality in patients with acute coronary syndrome compared to non-weekend admission?
Cohort (n=2,700)
Does weekend admission affect in-hospital mortality in patients with acute coronary syndrome compared to non-weekend admission?
Absolute Event Rate: 5.9% vs 9.4%
p-value: p=0.003
Weekend admission for acute coronary syndrome was not associated with higher in-hospital mortality compared to non-weekend admission, likely because non-weekend patients were older and sicker.
Lower weekend ACS mortality likely reflects sicker non-weekend patients; observational data leave open residual confounding and should not change practice.
Background: Acute coronary syndrome requires urgent diagnostic and therapeutic procedures, which may not be uniformly available throughout the week. So, we sought to examine the effects of admission on clinical outcomes in patients with wide spectrum coronary artery diseases. Methods: A retrospective analysis of ICCU Inpatient sample database of 17 months from 2015 to 2016 used to compare differences in in-hospital mortality between patients admitted on a non-weekday versus weekend for wide spectrum ACS which include STEMI, NSTEMI and unstable angina and patients with cardiogenic shock. Out of these 75% had higher TIMI risk score (5-7). Results: Total 2700 patients with ACS were included in the present study with wide spectrum coronary artery diseases. Out of that 20 % (n=541) were admitted in weekends and 79.9% (n=2159) were admitted in non-weekends. Total 804 females admitted on non-weekend had a mean age of 61.05±12 years and 162 females admitted on weekend had mean age 58.5±13.3 years (p value=0.025). Out of 2159 admitted on non-weekend, 1355 were males with mean age of 57.65±15.55 years and 379 were males admitted on weekend out of 541 patients with mean age of 56.85±13.1 years (p value =0.314). In-hospital mortality rate of these patients admitted on non-weekends was 9.4% (n=204) and those admitted on weekends was 5.9% (n=32) with statistically significant difference (95% CI; p= 0.003). The mortality rate of ACS without STEMI in non-weekend group was 8.6% (n=170) which was statistically significant (p = 0.006) with mortality of weekend group 5.3% (n=26). Conclusion: Our study shows that there is no added mortality in patients with coronary artery disease on weekend days compared with non-weekend days. As the patients admitted during non-weekend were elder and sicker than the weekend admissions (having the high risk score), the in-hospital mortality is higher on non-weekends. Efforts to improve health care system should ensure comparable outcomes for patients irrespective of time of hospital admission.
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Sandeep et al. (2017) conducted a cohort in Acute coronary syndrome (n=2,700). Weekend admission vs. Non-weekend admission was evaluated on In-hospital mortality (p=0.003). Weekend admission for acute coronary syndrome was associated with lower in-hospital mortality compared to non-weekend admission (5.9% vs 9.4%; p=0.003).
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