ST elevation myocardial infarction - national trend analysis with mortality differences in outcomes based on day of
Anil Jha1, Chandra P Ojha2, Pradnya Brijmohan Bhattad1
1Department of Cardiovascular Medicine, St. Vincent Hospital, UMass Chan Medical School, Worcester, Massachusetts.
Insights
Weekend STEMI admissions show no significant difference in mortality or hospital charges compared to weekday admissions. This finding suggests that emergent revascularization outcomes are consistent regardless of admission timing.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Acute ST-elevation myocardial infarction (STEMI) requires immediate revascularization.
- Investigating potential disparities in STEMI patient outcomes based on admission timing (weekends vs. weekdays) is crucial for healthcare quality.
Purpose of the Study:
- To compare in-hospital mortality, percutaneous coronary intervention (PCI) rates, transfer-out rates, length of stay (LOS), and total hospital charges for STEMI patients admitted during weekends versus weekdays.
Main Methods:
- Retrospective analysis of the 2016 Nationwide Inpatient Sample database.
- Included adult patients with STEMI diagnosis (ICD code).
- Weighted descriptive analysis and regression models adjusted for demographic and clinical factors.
Main Results:
- No significant difference in in-hospital mortality between weekend (27.9%) and weekday STEMI admissions (OR 1.04, P=0.498).
- Similar length of stay (4.1 days) and mean total hospital charges between weekend and weekday admissions.
- No significant difference in PCI utilization or transfer-out rates observed.
Conclusions:
- Admission timing for STEMI does not significantly impact in-hospital mortality, LOS, or hospital charges.
- Healthcare delivery for STEMI appears consistent across weekend and weekday admissions.
Background:
Patientswho present with acute ST elevation myocardial infarction (STEMI) need emergent revascularization. Our study aims to investigate the outcomes in patients with STEMI admitted during weekends versus weekdays.
Methods:
We conducted a retrospective analysis of the nationwide inpatient sample database. Patients with an admitting diagnosis of STEMI identified by the International Classification of Disease code for the year 2016 were analyzed. A weighted descriptive analysis was performed to generate national estimates. Patients admitted over the weekend were compared to those admitted over the weekday. Patients were stratified by demographic and clinical factors including the Elixhauser comorbidity index. The primary outcome was in-hospital mortality and secondary outcomes were percutaneous coronary intervention (PCI) utilization rate, rate of transfer-out, length of stay (LOS), and total hospital charges. Statistical analysis including linear and logistic regression was performed using STATA.
Results:
A total of 163 715 adult patients were admitted with STEMI, of which 27.9% (45 635) were admitted over the weekend. There were 76.2% Caucasians, 9.3% African Americans, and 8.0% Hispanics. Mean age of the patients was 63.2 years (95% CI, 62.9-63.5) for the weekend group and 63.7 years (95% CI, 63.5-63.9) for weekday admissions. The majority of the patients in both groups had Medicare (43.7% and 45.8% on weekends and weekdays, respectively; P = 0.0047). After adjusting for age, sex, race, income, Elixhauser comorbidity index, PCI use, hospital location, teaching status, and bed size, mortality was not significantly different in weekend versus weekday admissions (odds ratios 1.04; P = 0.498; 95% CI, 0.93-1.16). There was no significant difference in mean total charge per admission during the weekend versus weekday admissions ($107 093 versus $106 869; P = 0.99.) Mean LOS was 4.1 days for both groups (P = 0.81).
Conclusions:
There were no significant differences in mortality, LOS, or total hospital charge in STEMI patients being admitted during the weekend versus weekdays.
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