Abstract
Objectives
The effect of weekend versus weekday admission following acute coronary syndrome (ACS) on process of care and mortality remains controversial. This study aimed to investigate the “weekend-effect” on outcomes using a multicentre dataset of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction/ unstable angina (NSTEMI/ UA) patients.
Design
This retrospective observational study used propensity score stratification to adjust estimates of weekend effect for observed confounding. Logistic regression was used to estimate odds ratios (ORs) for binary outcomes and time-to-event endpoints were modelled using Cox proportional hazards to estimate hazard ratios (HRs).
Setting
Three tertiary cardiac centres in England and Wales that contribute to the Myocardial Ischaemia National Audit Project (MINAP).
Participants
Between January 2010 and March 2016, 17,705 admissions met the study inclusion criteria, 4,327 of which were at a weekend.
Primary and Secondary Outcomes
Associations were studied between weekend admissions and the following primary outcome measures: in-hospital mortality, 30-day mortality and long-term survival; secondary outcomes included several processes of care indicators, such as time to coronary angiography.
Results
After PS stratification adjustment, mortality outcomes were similar between weekend and weekday admission across STEMI and NSTEMI/ UA patients. Weekend admissions were less likely to be discharged within one day (HR 0.72, 95% CI: 0.66, 0.78), but after 4 days the length of stay was similar (HR 0.97, 95% CI: 0.90, 1.04). Fewer NSTEMI/ UA patients received angiography between 0 and 24 hours at a weekend (HR 0.71, 95% CI: 0.65, 0.77). Weekend STEMI patients were less likely to undergo an angiogram within 1 hour, but there was no significant difference after this time point.
Conclusion
ACS patients had similar mortality and processes of care when admitted on a weekend compared with a weekday. There was evidence of a delay to angiography for NSTEMI/ UA patients admitted at the weekend.
The effect of weekend versus weekday admission following acute coronary syndrome (ACS) on process of care and mortality remains controversial. This study aimed to investigate the “weekend-effect” on outcomes using a multicentre dataset of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction/ unstable angina (NSTEMI/ UA) patients.
Design
This retrospective observational study used propensity score stratification to adjust estimates of weekend effect for observed confounding. Logistic regression was used to estimate odds ratios (ORs) for binary outcomes and time-to-event endpoints were modelled using Cox proportional hazards to estimate hazard ratios (HRs).
Setting
Three tertiary cardiac centres in England and Wales that contribute to the Myocardial Ischaemia National Audit Project (MINAP).
Participants
Between January 2010 and March 2016, 17,705 admissions met the study inclusion criteria, 4,327 of which were at a weekend.
Primary and Secondary Outcomes
Associations were studied between weekend admissions and the following primary outcome measures: in-hospital mortality, 30-day mortality and long-term survival; secondary outcomes included several processes of care indicators, such as time to coronary angiography.
Results
After PS stratification adjustment, mortality outcomes were similar between weekend and weekday admission across STEMI and NSTEMI/ UA patients. Weekend admissions were less likely to be discharged within one day (HR 0.72, 95% CI: 0.66, 0.78), but after 4 days the length of stay was similar (HR 0.97, 95% CI: 0.90, 1.04). Fewer NSTEMI/ UA patients received angiography between 0 and 24 hours at a weekend (HR 0.71, 95% CI: 0.65, 0.77). Weekend STEMI patients were less likely to undergo an angiogram within 1 hour, but there was no significant difference after this time point.
Conclusion
ACS patients had similar mortality and processes of care when admitted on a weekend compared with a weekday. There was evidence of a delay to angiography for NSTEMI/ UA patients admitted at the weekend.
| Original language | English |
|---|---|
| Journal | BMJ Open |
| Volume | 7 |
| Issue number | 9 |
| DOIs | |
| Publication status | Published - 1 Sept 2017 |
Keywords
- Myocardial Infarction
- Process of care
- Acute Coronary Syndrome
- Resource Management
- weekend effect
