Off-hour admission and outcomes for patients with acute myocardial infarction undergoing percutaneous coronary
Atsushi Sorita1, Ryan J Lennon2, Qusay Haydour3
1Division of Preventive Medicine, Mayo Clinic, Rochester, MN.
Insights
Patients admitted for acute myocardial infarction (AMI) during off-hours did not experience higher mortality or readmission rates. This study found no significant difference in outcomes for weekend or holiday admissions compared to regular hours.
Area of Science:
- Cardiology
- Healthcare Management
- Clinical Outcomes Research
Background:
- Previous research indicated higher mortality for acute myocardial infarction (AMI) patients admitted during off-hours (nights, weekends, holidays).
- This perception suggests potential disparities in care quality or resource availability during non-regular working times.
Purpose of the Study:
- To investigate the association between off-hour admission for AMI and clinical outcomes, including mortality and readmissions.
- To determine if admission timing impacts patient prognosis following percutaneous coronary interventions.
Main Methods:
- Analysis of consecutive AMI patients (STEMI and non-STEMI) treated with percutaneous coronary interventions from 1998 to 2010.
- Multivariable logistic regression models adjusted for demographic and clinical variables to assess off-hour admission impact.
Main Results:
- Off-hour admissions were linked to higher rates of ST-elevation myocardial infarction (STEMI) and cardiogenic shock.
- No significant association was found between off-hour admission and in-hospital or 30-day mortality, or 30-day readmissions.
- Off-hour admission was significantly associated with composite major complications, including emergent coronary artery bypass graft surgery and stroke.
Conclusions:
- Off-hour admission for AMI at this academic medical center was not associated with increased mortality or readmission rates.
- While certain complications were more frequent, overall survival and readmission did not differ significantly based on admission timing.
Background:
Prior studies have suggested that patients with acute myocardial infarction (AMI) who are admitted during off-hours (weekends, nights and holidays) have higher mortality when compared with patients admitted during regular hours.
Methods:
We analyzed consecutive patients with AMI (ST-elevation myocardial infarction [STEMI] and non-STEMI) who were treated with percutaneous coronary interventions from January 1998 to June 2010 at an academic medical center. Multivariable logistic regression models were used to estimate the association between off-hour admission and clinical outcomes adjusted for demographic and clinical variables.
Results:
There were 3,422 and 2,664 patients with AMI admitted during off-hours and regular hours, respectively. Patients admitted during off-hours were more likely to have STEMI (56% vs 48%, P < .001), have cardiogenic shock at presentation (6% vs 4%, P = .002), and develop shock after presentation (6% vs 5%, P = .004). After multivariable analyses, off-hour admission was not significantly associated with in-hospital mortality (odds ratio [OR] 1.12, 95% CI 0.84-1.49), 30-day mortality (OR 1.12, 0.87-1.45), or 30-day readmissions (OR 1.01, 0.84-1.20) but was significantly associated with composite major complications and any of emergent coronary artery bypass graft surgery, ventricular arrhythmia, stroke/transient ischemic attack, and gastrointestinal/retroperitoneal/intracranial bleeding (OR 1.27, 1.05-1.55, P = .015). There was no significant time trend in the adjusted mortality difference between off-hours and regular hours. The results were not different between STEMI and non-STEMI.
Conclusions:
Patients who were admitted during off-hours did not have higher mortality or readmission rates as compared with ones admitted during regular hours at an academic medical center.
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