In-Hospital and Postdischarge Mortality Among Patients With Acute Decompensated Heart Failure Hospitalizations Ending...

Area of Science:

• Cardiology
• Healthcare Management
• Public Health

Background:

• Reduced hospital staffing on weekends may affect patient care and post-discharge coordination.
• Limited research exists on weekend vs. weekday in-hospital mortality and post-hospital outcomes for acute decompensated heart failure (ADHF) patients.

Purpose of the Study:

• To investigate the association between hospitalization timing (weekend vs. weekday) and in-hospital mortality for ADHF patients.
• To examine the impact of discharge timing (weekend vs. weekday) on 28-day post-hospital mortality in ADHF survivors.

Main Methods:

• A stratified sample of ADHF hospitalizations was analyzed from 4 US regions (2005-2014) using the ARIC study's Community Surveillance component.
• ADHF cases were identified via a standardized algorithm and medical record review; weekend events included Saturdays, Sundays, and national holidays.
• In-hospital and 28-day post-discharge mortality were compared between weekend and weekday events/discharges, adjusting for confounders.

Main Results:

• Nearly 20% of 39,699 weighted ADHF hospitalizations occurred on weekends, with similar patient demographics, comorbidities, and treatment intensity compared to weekdays.
• In-hospital mortality was significantly higher for ADHF hospitalizations ending on a weekend (12%) versus a weekday (6%), a doubling effect (OR, 2.37) not explained by confounders.
• No significant association was found between weekend discharge and increased 28-day mortality among patients discharged alive.

Conclusions:

• Patients hospitalized with ADHF face a doubled risk of in-hospital death when their hospitalization concludes on a weekend, likely due to reduced staffing.
• Discharge timing on a weekend does not appear to negatively impact the 28-day survival outcomes for patients with acute decompensated heart failure who are discharged alive.