1
|
Mellacheruvu SP, Lekkala SP, Khela PS, Singh G, Gill KS, Vaghani UP, Jitta SR, Hingora MJ, Patel M, Dadana S, Desai R. Was there a weekend effect on mortality rates for hospitalized patients with COVID-19 and acute myocardial infarction? Insights from the National Inpatient Sample, 2020. J Med Life 2024; 17:286-291. [PMID: 39044923 PMCID: PMC11262605 DOI: 10.25122/jml-2023-0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/12/2024] [Indexed: 07/25/2024] Open
Abstract
Our study aimed to assess the effect of weekend versus weekday hospital admissions on all-cause mortality in patients with acute myocardial infarction (AMI) and COVID-19 during the COVID-19 pandemic. We analyzed data from the National Inpatient Sample (NIS) 2020, identifying patients with co-existing AMI and COVID-19 admitted on weekdays and weekends. Baseline demographics, comorbidities, and outcomes were assessed. A multivariable regression analysis was conducted, adjusting for confounders to determine the odds of all-cause mortality. Among 74,820 patients, 55,145 (73.7%) were admitted on weekdays, while 19,675 (26.3%) were admitted on weekends. Weekend admissions showed slightly higher proportions of men (61.3% vs. 60%) and whites (56.3% vs. 54.9%) with a median age of 73 years (range: 62-82). The overall all-cause mortality had an odds ratio (OR) of 1.00 (95% CI, 0.92-1.09; P = 0.934). After adjusting for covariates, there was no significant associations between mortality and hospital type (rural: OR = 1.04; 95% CI, 0.78-1.39; P = 0.789; urban teaching: OR = 1.04; 95% CI, 0.94-1.14; P = 0.450) or geographic region (Northeast: OR = 1.16; 95% CI, 0.96-1.39; P = 0.12; Midwest: OR = 0.99; 95% CI, 0.83-1.17; P = 0.871; South: OR = 0.97; 95% CI, 0.85-1.12; P = 0.697; West: OR = 0.94; 95% CI, 0.77-1.15; P = 0.554). There was no significant difference in the rate of all-cause mortality among patients admitted for AMI and COVID-19 between weekdays and weekends.
Collapse
Affiliation(s)
| | | | - Puneeteshwar Singh Khela
- Department of Internal Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, India
| | - Gurjot Singh
- Department of Internal Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, India
| | - Karanvir Singh Gill
- Department of Internal Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, India
| | | | - Sahas Reddy Jitta
- Department of Internal Medicine, Mercy Hospital, St Louis, Missouri, USA
| | - Mohmed Junaid Hingora
- Department of Internal Medicine, Pandit Deendayal Upadhyay Medical College, Rajkot, India
| | - Manali Patel
- Department of Internal Medicine, Gastroenterology and Internal Medicine Specialists, Lake Barrington, Illinois
| | - Sriharsha Dadana
- Department of Hospital Medicine, Cheyenne Regional Medical Center, Cheyenne, USA
| | | |
Collapse
|
2
|
Matter MA, Candreva A, Stähli BE, Heg D, Klingenberg R, Räber L, Windecker S, Rodondi N, Nanchen D, Mach F, Gencer B, Ruschitzka F, Matter CM, Templin C. Higher 1-year mortality on rest days in patients with acute coronary syndromes and decompensated heart failure-A SPUM-ACS sub-study. Catheter Cardiovasc Interv 2024; 103:286-294. [PMID: 38145467 DOI: 10.1002/ccd.30938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/11/2023] [Accepted: 12/10/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Acute coronary syndromes (ACS) occurring on rest days have been associated with higher mortality, but the current literature remains inconsistent in this regard. This study included ACS patients presenting with acute decompensated heart failure (ADHF) investigating the relationship between time of coronary catheterization and outcomes. METHODS Analyses were performed from the prospective, multicentric Special Program University Medicine Acute Coronary Syndromes and Inflammation (SPUM-ACS) Cohort. Patients were divided into two groups according to time of coronary catheterization on either workdays (Monday, 00:00 to Friday, 23:59) or rest days (Saturday, 00:00 to Sunday, 23:59 and public holidays). ADHF was defined by Killip Class III or IV upon presentation. Patients were followed over 1 year. RESULTS Out of 4787 ACS patients enrolled in the SPUM-ACS Cohort, 207 (4.3%) presented with ADHF. 52 (25.1%) and 155 (74.9%) patients underwent coronary angiography on rest days or workdays, respectively. Baseline characteristics were similar among these groups. ACS patients with ADHF showed increased 1-year mortality on rest days (34.6% vs. 17.4%, p-value = 0.009). After correction for baseline characteristics, including the GRACE 2.0 Score, rest day presentation remained a significant predictor for 1-year mortality (adjusted hazard ratio = 2.42 [95% confidence interval: 1.14-5.17], p-value = 0.022). CONCLUSIONS One-year all-cause mortality was high in ACS patients with ADHF and doubled for patients admitted on rest days. The present data support the association of a rest day effect and long-term patient survival and indicate a need for further investigations.
Collapse
Affiliation(s)
- Michael A Matter
- Department of Cardiology, Zurich and Center for Translational and Experimental Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alessandro Candreva
- Department of Cardiology, Zurich and Center for Translational and Experimental Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Barbara E Stähli
- Department of Cardiology, Zurich and Center for Translational and Experimental Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Dik Heg
- Clinical Trial Unit, University of Bern, Bern, Switzerland
| | | | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - David Nanchen
- Centre for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - François Mach
- Department of Cardiology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Baris Gencer
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of Cardiology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, Zurich and Center for Translational and Experimental Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christian M Matter
- Department of Cardiology, Zurich and Center for Translational and Experimental Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christian Templin
- Department of Cardiology, Zurich and Center for Translational and Experimental Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
3
|
Dharma S, Kamarullah W, Sabrina AP. Association of Admission Time and Mortality in STEMI Patients: A Systematic Review and Meta-analysis. Int J Angiol 2022; 31:273-283. [PMID: 36588865 PMCID: PMC9803553 DOI: 10.1055/s-0042-1742610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
This systematic review and meta-analysis aimed to evaluate patients with acute ST-segment elevation myocardial infarction (STEMI) who were admitted during off-hours and treated with primary angioplasty associated with an increased risk of mortality compared with those admitted during regular working hours. We performed a systematic literature search using PubMed, SCOPUS, Europe PMC, and Cochrane CENTRAL databases that was finalized on March 15, 2021. The primary outcome was mortality comprising early (in-hospital), midterm (30 days to 1 year), and long-term mortality (>1 year). A total of 384,452 patients from 56 studies were included. The overall mortality of acute STEMI patients admitted during off-hours and regular hours were 6.1 and 6.7%, respectively. Patients admitted during off-hours had similar risk of early, midterm, and long-term mortality compared to those admitted during regular working hours ([relative risk or RR = 1.07, 95% confidence interval or CI, 1.00-1.14, p = 0.06; I 2 = 45%, p = 0.0009], [RR = 1.00, 95% CI, 0.95-1.05, p = 0.92; I 2 = 13%, p = 0.26], and [RR = 0.95, 95% CI, 0.86-1.04, p = 0.26; I 2 = 0%, p = 0.76], respectively). Subgroup analyses indicated that the results were consistent across all subgroups ([women vs. men], [age >65 years vs. ≤65 years], and [Killip classification II to IV vs. Killip I]). Funnel plot was asymmetrical. However, Egger's test suggests no significance of small-study effects ( p = 0.19). This meta-analysis showed that patients with acute STEMI who were admitted during off-hours and treated with primary angioplasty had similar risk of early, midterm, and long-term mortality compared with those admitted during regular working hours.
Collapse
Affiliation(s)
- Surya Dharma
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
- Faculty of Medicine, University of Prima Indonesia, Medan, Indonesia
| | - William Kamarullah
- Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Adelia Putri Sabrina
- Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| |
Collapse
|
4
|
Takahashi T, Yoshino H, Akutsu K, Shimokawa T, Ogino H, Kunihara T, Usui M, Watanabe K, Kawata M, Masuhara H, Yamasaki M, Yamamoto T, Nagao K, Takayama M. In-Hospital Mortality of Patients With Acute Type A Aortic Dissection Hospitalized on Weekends Versus Weekdays. JACC. ASIA 2022; 2:369-381. [PMID: 36338400 PMCID: PMC9627801 DOI: 10.1016/j.jacasi.2021.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 11/03/2021] [Accepted: 11/03/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND In acute aortic dissection, weekend admissions are reported to be associated with increased mortality compared with weekday admissions. OBJECTIVE This study aimed to determine whether patients with acute type A aortic dissection (ATAAD) admitted on weekends had higher in-hospital mortality than those admitted on weekdays in the Tokyo metropolitan area, where we developed a patient-transfer system for aortic dissection. METHODS Data were collected during the first year after our transfer system began (cohort I) and in the subsequent years from 2013 to 2015 (cohort II). RESULTS We studied 2,339 patients (500 in cohort I; 1,839 in cohort II) with ATAAD. Patients with weekend admissions had higher in-hospital mortality than those with weekday admissions in cohort I. In association with increased interfacility transfer during weekends and reduced mortality at non-high-volume centers, the in-hospital mortality in the weekend group improved from 37.2% in cohort I to 22.2% in cohort II (P < 0.001). After inverse probability weighting adjustment, weekend admission was associated with higher in-hospital mortality in cohort I (odds ratio: 2.28; 95% confidence interval: 1.48 to 3.52; P < 0.001), but not in cohort II (odds ratio: 0.96; 95% confidence interval: 0.75 to 1.22; P = 0.731). On multivariable analyses, weekend admission was associated with higher in-hospital mortality in combined cohort I+II; the associations between weekend admission and mortality were not significant in cohort II. CONCLUSIONS We found a significant reduction in in-hospital mortality in patients with weekend admissions for ATAAD. No mortality difference between weekend and weekday admissions was observed in the later years of the study.
Collapse
Affiliation(s)
- Toshiyuki Takahashi
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
- Department of Cardiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | | | - Koichi Akutsu
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Hitoshi Ogino
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Michio Usui
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | | | | | | | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | |
Collapse
|
5
|
Yu YY, Zhao BW, Ma L, Dai XC. Association Between Out-of-Hour Admission and Short- and Long-Term Mortality in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 8:752675. [PMID: 34970604 PMCID: PMC8712470 DOI: 10.3389/fcvm.2021.752675] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/18/2021] [Indexed: 01/14/2023] Open
Abstract
Objectives: Out-of-hour admission (on weekends, holidays, and weekday nights) has been associated with higher mortality in patients with acute myocardial infarction (AMI). We conducted a meta-analysis to verify the association between out-of-hour admission and mortality (both short- and long-term) in AMI patients. Design: This Systematic review and meta-analysis of cohort studies. Data Sources: PubMed and EMBASE were searched from inception to 27 May 2021. Eligibility Criteria for Selected Studies: Studies of any design examined the potential association between out-of-hour admission and mortality in AMI. Data Extraction and Synthesis: In total, 2 investigators extracted the data and evaluated the risk of bias. Analysis was conducted using a random-effects model. The results are shown as odds ratios [ORs] with 95% confidence intervals (CIs). I2 value was used to estimate heterogeneity. Grading of Recommendations Assessment, Development, and Evaluation was used to assess the certainty of the evidence. Results: The final analysis included 45 articles and 15,346,544 patients. Short-term mortality (defined as either in-hospital or 30-day mortality) was reported in 42 articles (15,340,220 patients). Out-of-hour admission was associated with higher short-term mortality (OR 1.04; 95%CI 1.02–1.05; I2 = 69.2%) but there was a significant statistical indication for publication bias (modified Macaskill's test P < 0.001). One-year mortality was reported in 10 articles (1,386,837 patients). Out-of-hour admission was also associated with significantly increased long-term mortality (OR 1.03; 95%CI 1.01–1.04; I2 = 66.6%), with no statistical indication of publication bias (p = 0.207). In the exploratory subgroup analysis, the intervention effect for short-term mortality was pronounced among patients in different regions (p = 0.04 for interaction) and socio-economic levels (p = 0.007 for interaction) and long-term mortality was pronounced among patients with different type of AMI (p = 0.0008 for interaction) or on different types of out-to-hour admission (p = 0.006 for interaction). Conclusion: Out-of-hour admission may be associated with an increased risk of both short- and long-term mortality in AMI patients. Trial Registration: PROSPERO (CRD42020182364).
Collapse
Affiliation(s)
- Yue-Yan Yu
- Department of Cardiology, Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Bo-Wen Zhao
- Department of Cardiology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Lan Ma
- Department of Cardiology, Affiliated Hospital of Nantong University, Nantong, China
| | - Xiao-Ce Dai
- Department of Cardiology, Affiliated Hospital of Jiaxing University, Jiaxing, China
| |
Collapse
|
6
|
Dafaalla M, Rashid M, Weston C, D'Ascenzo F, De Ferrari GM, Hussain ST, Mohamed MO, Shoaib A, Curzen N, Mamas MA. Effect of the Timing of Admission of Out of Hospital Cardiac Arrest Complicating Acute Myocardial Infarction on Management and Outcome. Am J Cardiol 2021; 156:1-8. [PMID: 34353630 DOI: 10.1016/j.amjcard.2021.06.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Abstract
There is limited data regarding the impact of time of admission on clinical outcomes of out of hospital cardiac arrest (OHCA) complicating acute myocardial infarction (AMI). We investigated the patient characteristics, management, and outcomes of OHCA complicating AMI according to the time of admission. Patients admitted with a diagnosis of AMI and OHCA between 2010 and 2017 from the Myocardial Ischemia National Audit Project (MINAP) were studied. All patients were stratified into out-of-hours (OOH) and working hours (WH) cohort according to the time of hospital admission. We used multivariable logistic regression models to evaluate the predictors of clinical outcomes and treatment strategy. 16,118 patients were admitted with AMI and OHCA. The WH cohort consisted of 5,780 patients (35.9%) and OOH cohort consisted of 10,338 patients (64.1%). The OOH cohort was younger (OOH 64 vs WH 66 years, p <0.001). A significantly higher proportion of patients had a final diagnosis of STEMI in OOH cohort (OOH 78.3% vs WH 76.6%, p = 0.012). Whilst the use of coronary angiography was lower in OOH (OOH 80.7% vs WH 82.5%, p = 0.005), PCI rates were similar (OOH 39.7% vs WH 40.5%, p = 0.4). Adjusted in-hospital mortality (OR 0.96, 95%CI 0.86 to 1.07), re-infarction (OR 0.90, 95% CI 0.72 to 1.12) and bleeding (OR 0.93, 95% CI 0.76 to 1.12) were similar in the 2 groups. In conclusion, the majority of OHCA occurred out of working hours. However, the time of hospital admission didn't affect the rate of revascularization by PCI or clinical outcomes.
Collapse
|
7
|
Off-hours admission does not impact outcomes in patients undergoing primary percutaneous coronary intervention and with a first medical contact-to-device time within 90 min. Chin Med J (Engl) 2021; 134:1795-1802. [PMID: 34172617 PMCID: PMC8367027 DOI: 10.1097/cm9.0000000000001621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: It remains unclear whether the outcomes of ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI) during off-hours are as favorable as those treated during on-hours, especially those with a first medical contact-to-device (FMC-to-device) time within 90 min. We aimed to determine whether off-hours admission impacted late outcomes in patients undergoing PPCI and with an FMC-to-device time ≤90 min. Methods: This multicenter retrospective study included 670 STEMI patients who underwent successful PPCI and had an FMC-to-device time ≤90 min from 19 chest pain centers in Beijing from January 2018 to December 2018. Patients were divided into on-hours group and off-hours group based on their arrival time. Baseline characteristics, clinical data, and key time intervals during treatment were collected from the Quality Control & Improvement Center of Cardiovascular Intervention of Beijing by the “Heart and Brain Green Channel” app. Results: Overall, the median age of the patients was 58.8 years and 19.9% (133/670) were female. Of these, 296 (44.2%) patients underwent PPCI during on-hours and 374 (55.8%) patients underwent PPCI during off-hours. Compared with the on-hours group, the off-hours group had a longer FMC-to-device time and fewer patients with FMC-to-device time ≤60 min (P < 0.05). During the mean follow-up period of 24 months, a total of 64 (9.6%) participants experienced a major adverse cardiovascular event (MACE), with 28 (9.1%) in the on-hours group and 36 (9.6%) in the off-hours group (P > 0.05). According to the Cox regression analyses, off-hours admission was not a predictor of 2-year MACEs (P = 0.788). Similarly, the Kaplan-Meier curves showed that the risks of a MACE, all-cause death, reinfarction, and target vessel revascularization were not significantly different between the two groups (P > 0.05). Conclusions: This real-world, multicenter retrospective study demonstrated that for STEMI patients who underwent PPCI within 90 min, off-hours admission was safe, with no difference in the risk of 2-year MACEs compared with those with on-hours admission.
Collapse
|
8
|
Ischaemic Heart Disease Mortality Increased With Weekend Admission: Results From a Large, Comprehensive Admission Cohort in Australia. Heart Lung Circ 2020; 30:861-868. [PMID: 33250400 DOI: 10.1016/j.hlc.2020.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 10/07/2020] [Accepted: 10/15/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The phenomenon of the "weekend effect", whereby patient outcomes are significantly worse for those admitted to hospital on the weekend as compared to weekdays, is well-documented in systematic reviews and meta-analyses in the literature. We sought to assess the effect of the time of a patient's admission on outcomes across an entire cardiology admissions cohort and explore other factors that have been previously identified or proposed to influence these outcomes, including admissions out-of-hours, and patient transfers from other facilities. METHODS We conducted a retrospective cohort study involving cardiology admissions at a large tertiary referral centre across a 6-year period from 1 January 2012 to 31 December 2017. Outcomes were in-hospital, 30-day and 1-year mortality rates as well as length-of-stay, and readmission rate. 14,078 patients admitted under a cardiologist across the 6-year period were identified, with 3,029 elective patients excluded. Patients were stratified into weekday (n=8,951) or weekend (n=2,098) categories. RESULTS In-hospital mortality for weekend admissions was noted to be significantly higher compared to weekday admissions (adj OR 1.78, 95% CI 1.40-2.28; p<0.001). Mortality for weekend admissions was also higher at 30-days (adj OR 1.74, 95% CI 1.39-2.17; p<0.001) and at 1-year (adj OR 1.33 95% CI 1.14-1.55; p<0.001). Adjusted for diagnosis, there was a significant increase in in-hospital, 30-day and 1-year mortality seen only for weekend admissions with the final diagnosis of acute myocardial infarction. CONCLUSION We have identified an association between weekend admissions and higher in-hospital, 30-day and 1-year mortality for the final diagnosis of acute myocardial infarction in our cardiology admissions data over an extended period of time, although confounders cannot be completely discounted. Any steps to reduce the weekend effect need to move to a system where weekend practices are not substantially different to a usual business day. The question of whether changes in organisation practice and the increased costs incurred would reduce mortality in this high-risk group needs to be addressed by further directed research.
Collapse
|
9
|
Czapla M, Zyśko D, Quinn T, Karniej P. Complication during transportation and 30 days mortality of patients with acute coronary syndrome. BMC Cardiovasc Disord 2020; 20:19. [PMID: 31952496 PMCID: PMC6969437 DOI: 10.1186/s12872-020-01327-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 01/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Patients with acute coronary syndrome (ACS) who present to hospitals without interventional facilities frequently require transfer to another hospital equipped with a cardiac catheterization laboratory. This retrospective cohort study evaluates the association of the type of medical transport with patient outcomes. Methods A retrospective analysis of medical records of patients with ACS transported by basic (BT) and specialist transfer (ST) by emergency medical teams (EMTs). We analyzed age, gender, hemodynamic parameters, type of the emergency medical team, and complications during transport as well as patient survival to hospital admission, survival time and the 30-day mortality rate. Results Of 500 patients who underwent transfer, ST transported 368 (73.6%) and BT 132 (26.4%) patients (p < 0.001). Complications during transportation occurred in 3 (1%) in the ST group and 2 (1.5%) in and BT group. Cardiac arrest during transfer occurred in no (0%) patients in the ST group, and 2 (1.5%) in the BT group (p = 0.118). Survival to admission was recorded in all patients in the ST group and 131/132 (0.8%) patients in the BT group (p = 0.592). 40 (12%) of patients in the ST group and 13 (11%) patients in the BT group (p = 0.731) died within 30 days of transfer. Conclusions Complications during medical transport of ACS patients from hospitals without a cardiac catheter lab to hospitals equipped with such a lab were rare and their incidence was not associated with the type of transporting EMT. The type of EMT was not associated with 30-day patient mortality.
Collapse
Affiliation(s)
- Michał Czapla
- Department of Organisation and Management, Faculty of Health Sciences, Wroclaw Medical University, Bartla 5, 51-618, Wroclaw, Poland.
| | - Dorota Zyśko
- Department of Emergency Medicine, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Tom Quinn
- Faculty of Health, Social Care and Education Kingston University and St George's, University of London, London, UK
| | - Piotr Karniej
- Department of Organisation and Management, Faculty of Health Sciences, Wroclaw Medical University, Bartla 5, 51-618, Wroclaw, Poland
| |
Collapse
|
10
|
Roberts SE, John A, Lewis KE, Brown J, Lyons RA, Williams JG. Weekend admissions and mortality for major acute disorders across England and Wales: record linkage cohort studies. BMC Health Serv Res 2019; 19:619. [PMID: 31477110 PMCID: PMC6720086 DOI: 10.1186/s12913-019-4286-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 06/20/2019] [Indexed: 11/17/2022] Open
Abstract
Background To establish which major disorders are susceptible to increased mortality following acute admissions on weekends, compared with week days, and how this may be explained. Methods Cohorts based on national administrative inpatient and mortality data for 14,168,443 hospitalised patients in England and 913,068 in Wales who were admitted for 66 disorders that were associated with at least 200 deaths within 30 days of acute admission. The main outcome measure was the weekend mortality effect (defined as the conventional mortality odds ratio for admissions on weekends compared with week days). Results There were large, statistically significant weekend mortality effects (> 20%) in England for 22 of the 66 conditions and in both countries for 14. These 14 were 4 of 13 cancers (oesophageal, colorectal, lung and lymphomas); 4 of 13 circulatory disorders (angina, abdominal aortic aneurysm, peripheral vascular disease and arterial embolism & thrombosis); one of 8 respiratory disorders (pleural effusion); 2 of 12 gastrointestinal disorders (alcoholic and other liver disease); 2 of 3 ageing-related disorders (Alzheimer’s disease and dementia); none of 7 trauma conditions; and one of 10 other disorders (acute renal failure). Across the disorders, 64% of the variation in weekend mortality effects in England and Wales was explained by reductions in admission rates at weekends and the medical disease category. Conclusions The effect of weekend admission on 30 day mortality is seen mainly for cancers, some circulatory disorders, liver disease and a few other conditions which are mainly ageing- or cancer-related. Most of the increased mortality is associated with reduced admission rates at weekends and the medical disease category. Electronic supplementary material The online version of this article (10.1186/s12913-019-4286-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Stephen E Roberts
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, UK. .,Health Data Research UK, Swansea University, Swansea, UK.
| | - Ann John
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, UK.,Health Data Research UK, Swansea University, Swansea, UK
| | - Keir E Lewis
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, UK.,Department of Respiratory Medicine, Prince Philip Hospital, Llanelli, UK
| | - Jonathan Brown
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, UK.,Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
| | - Ronan A Lyons
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, UK.,Health Data Research UK, Swansea University, Swansea, UK
| | - John G Williams
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, UK.,Health Data Research UK, Swansea University, Swansea, UK
| |
Collapse
|
11
|
Soni KD, Mahindrakar S, Kaushik G, Kumar S, Sagar S, Gupta A. Do the Care Process and Survival Chances Differ in Patients Arriving to a Level 1 Indian Trauma Center, during-Hours and after-Hours? J Emerg Trauma Shock 2019; 12:128-134. [PMID: 31198280 PMCID: PMC6557059 DOI: 10.4103/jets.jets_76_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Trauma systems vary in performance during different time periods and may affect the patient outcomes, especially in resource-limited settings. The present study was undertaken to study the pattern, epidemiological profile, processes of care variations of trauma victims presenting during-hours and after-hours in a level 1 trauma Center of a lower middle-income country. Methodology Retrospective analyses of prospectively collected data registry at a single tertiary care center. Data collected from 2013 to 2015 were analyzed. Patients with a history of trauma and admission to the center or death between arrival and admission were included. Isolated limb injury and patients dead on arrival were excluded. Results Of 4692, 1789 (38.1%) patients arrived and were admitted during-hours and 2903 (61.9%) after-hours. The overall in-hospital mortality was 14.9% in the cohort. Moreover, it was 16.10% during after-hours in comparison to 13.0% during-hours. The Revised Trauma Score was statistically different during-hours and after-hours suggesting patients with greater physiological derangement after-hours. The Kaplan-Meier survival curves for 7 days were comparable in two groups with the log-rank test of 078. The proportion of initial radiological investigations (chest X-ray, focused assessment sonography in trauma [FAST], and computerized tomography [CT] scans) was ranged from 84.9% for CT scans in the cohort to 99.3% for FAST. Conclusions Processes of care do not differ significantly for the patients admitted at a level 1 trauma center irrespective of time of the day. Although survival probability for the initial 7 days of follow-up is comparable between two groups; however, for 30 and 90 days of follow-up they are significantly different between during-hours and after-hours, likely due to injury severity.
Collapse
Affiliation(s)
- Kapil Dev Soni
- Department of Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Santosh Mahindrakar
- Department of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurav Kaushik
- Department of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Subodh Kumar
- Department of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Sagar
- Department of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Gupta
- Department of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
12
|
Chongprasertpon N, Coughlan JJ, Cahill C, Kiernan TJ. Circadian and seasonal variations in patients with acute STEMI: A retrospective, single PPCI center study. Chronobiol Int 2018; 35:1663-1669. [PMID: 30067392 DOI: 10.1080/07420528.2018.1500478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This was a retrospective observational analysis of all (n = 876) ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI) at University Hospital Limerick (UHL) from 2012 to 2016 to determine whether chronological patterns existed in incidence and mortality at our center. Data were obtained from the electronic Cardiology STEMI database in UHL. Statistical analysis was performed using the Independent Samples t Test, ANOVA and Pearson's Chi-Squared test. The rate of STEMI from 0800 and 2259 hours (46.9/hr) was greater than 2300 to 0759 hours (19.1/hr) (p < 0.001). No association was found between 30-day mortality and weekend/weekdays presentation (p = 0.81) or off/in hour presentation (p = 0.86). No seasonal variation was found in STEMI incidence at our center using international (p = 0.29) or Celtic (p = 0.82) seasonal calendars. 30-Day mortality is equivalent whether STEMI patients treated with PPCI present during "normal working hours" or during the "out of hours"/weekend period at our center. The majority of STEMIs occur during the hours 0800 to 2259, but no further chronological relationship was observed in incidence.
Collapse
Affiliation(s)
| | - John Joseph Coughlan
- a Department of Cardiology , University Hospital Limerick , Co. Limerick , Ireland
| | - Ciara Cahill
- a Department of Cardiology , University Hospital Limerick , Co. Limerick , Ireland
| | - Thomas John Kiernan
- a Department of Cardiology , University Hospital Limerick , Co. Limerick , Ireland
| |
Collapse
|
13
|
Abstract
BACKGROUND Apparent increase in mortality associated with being admitted to hospital on a weekend compared to weekdays has led to controversial policy changes to weekend staffing in the United Kingdom. Studies in the United States have been inconclusive and diagnosis specific, and whether to implement such changes is subject to ongoing debate. OBJECTIVE To compare mortality, length of stay, and cost between patients admitted on weekdays and weekends. DESIGN Retrospective cohort study. SETTING National Inpatient Sample, an administrative claims database of a 20% stratified sample of discharges from all hospitals participating in the Healthcare Cost and Utilization Project. PATIENTS Adult patients who were emergently admitted from 2012 to 2014. INTERVENTION The primary predictor was whether the admission was on a weekday or weekend. MEASUREMENTS The primary outcome was in-hospital mortality and secondary outcomes were length of stay and cost. RESULTS We included 13,505,396 patients in our study. After adjusting for demographics and disease severity, we found a small difference in inpatient mortality rates on weekends versus weekdays (odds ratio [OR] 1.029; 95% confidence interval [CI], 1.020-1.039; P < .001). There was a statistically significant but clinically small decrease in length of stay (2.24%; 95% CI, 2.16-2.33; P < .001) and cost (1.14%; 95% CI, 1.05-1.24; P < .001) of weekend admissions. A subgroup analysis of the most common weekend diagnoses showed substantial heterogeneity between diagnoses. CONCLUSIONS Differences in mortality of weekend admissions may be attributed to underlying differences in patient characteristics and severity of illness and is subject to large between-diagnoses heterogeneity. Increasing weekend services may not result in desired reduction in inpatient mortality rate.
Collapse
Affiliation(s)
- Stephanie Q Ko
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
- National University Hospital, Singapore
| | - Jordan B Strom
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Changyu Shen
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
14
|
Bech CN, Brabrand M, Mikkelsen S, Lassen A. Risk factors associated with short term mortality changes over time, after arrival to the emergency department. Scand J Trauma Resusc Emerg Med 2018; 26:29. [PMID: 29678207 PMCID: PMC5910601 DOI: 10.1186/s13049-018-0493-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 03/27/2018] [Indexed: 12/01/2022] Open
Abstract
Background Preventing death is the most important outcome pursued in the Emergency Department. Prompt accurate assessment, followed by competent and efficient investigation and treatment is the recipe sought. Abnormal physiological measurements are common antecedents to deterioration and therefore a cornerstone in many risk stratification tools. Some risk factors have their impact during the first few days after admittance, others have higher impact on 30 day mortality. Understanding the variance in impact of risk factors is relevant for future composition of risk stratification models. Methods We included patients aged 18 years or older, registered at the Emergency Department at Odense University Hospital from April 1st 2012 to September 30th 2014. We performed multivariate logistic regressions, adjusted for age, gender and comorbidity, to describe the relationship between potential risk factors and measures of short term mortality. Results A total of 43,178 were eligible for analysis. Median age was 56 (IQR 36–72) and 48.3% were males. The over-all 30-day-mortality was 4%. One third of deaths occurred within the first 2 days. Higher age, male gender and comorbidity are all associated with immediate, 0-2 day, 3-7 day and 8–30 day mortality. The degree of acuteness at arrival defined by urgency-level, physician-assisted transfer to the Emergency Department and abnormal vital parameters are associated with 0-2 day mortality. High temperature at arrival shows no association in either mortality-group. Missing values are associated with immediate and 0–2 day mortality, but no association with mortality after 7 days. Discussion Abnormal vital parameters and degree of acuity at admission were strongly associated with mortality in the first hours and days after admission, where after the association decreased. The effect of other risk factors such as male gender, comorbidity and high age were time stable or even increasing over time.. Conclusions The over-all 30-day mortality was 4%. Physiology–related risk factors varied in strength of association throughout different mortality outcome measures. Electronic supplementary material The online version of this article (10.1186/s13049-018-0493-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Camilla Nørgaard Bech
- Department of Emergency Medicine, Odense University Hospital, Sdr. Boulevard 29, entrance 130, 1st floor, DK-5000, Odense C, Denmark.
| | - Mikkel Brabrand
- Department of Emergency Medicine, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Søren Mikkelsen
- Mobile Emergency Care Unit, Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark
| | - Annmarie Lassen
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| |
Collapse
|
15
|
Sheikh HQ, Aqil A, Hossain FS, Kapoor H. There is no weekend effect in hip fracture surgery - A comprehensive analysis of outcomes. Surgeon 2017; 16:259-264. [PMID: 29191435 DOI: 10.1016/j.surge.2017.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/15/2017] [Accepted: 11/05/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Previous studies have shown that some patient groups suffer adverse outcomes if they are acutely admitted to hospital over a weekend. We aimed to investigate this 'weekend effect' at our centre in patients presenting with a hip fracture. METHODS Consecutive patients undergoing acute hip fracture surgery were identified from a prospective database. Patient demographics, co-morbidities, fracture type, admission blood parameters were examined. Outcomes analysed included 30-day, 90-day and 1-year mortality as well as length of stay, re-operations and delay to surgery. The data were analysed with regards to day of admission and day of surgery separately. RESULTS A total of 1326 patients were included, of which 368 patients were admitted over a weekend and 411 patients had their operation over a weekend. Overall 30-day mortality was 7.6% (101 patients), whilst the 90-day and 1-year mortalities were 15.3% and 26.8% (203 and 356 patients). There were no significant differences in any of the outcomes based on the day of admission or the day of surgery. Multivariate analysis for 30-day mortality demonstrated the following variables to be significant predictors: admission urea levels (hazard ratio (HR) 1.042, p = 0.027), age (HR 1.058, p < 0.001), admission source (HR 1.428, p < 0.001), surgical delay >48 h (HR 1.853, p = 0.004), male gender (HR 1.967, p = 0.003), previous stroke (HR 2.261, p = 0.038), acute chest infection (4.240, p < 0.001) and chronic liver disease (HR 4.581, p = 0.014). CONCLUSION This data suggests that there is no significant weekend effect in hip fracture surgery and mortality is affected by patient co-morbidities and delay to surgery.
Collapse
Affiliation(s)
- Hassaan Q Sheikh
- Department of Trauma and Orthopaedics, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom.
| | - Adeel Aqil
- Department of Trauma and Orthopaedics, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom
| | - Fahad S Hossain
- Department of Trauma and Orthopaedics, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom
| | - Harish Kapoor
- Department of Trauma and Orthopaedics, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom
| |
Collapse
|