Weekend versus Weekday Admission and Mortality from Myocardial Infarction
William J. Kostis, Ph.D., Kitaw Demissie, M.D., Ph.D., Stephen W. Marcella, M.D., M.P.H., Yu-Hsuan Shao, M.H.S., Alan C. Wilson, Ph.D., Abel E. Moreyra, M.D., for the Myocardial Infarction Data Acquisition System (MIDAS 10) Study Group
Background Management of acute myocardial infarction requiresurgent diagnostic and therapeutic procedures, which may notbe uniformly available throughout the week.
Methods We examined differences in mortality between patientsadmitted on weekends and those admitted on weekdays for a firstacute myocardial infarction, using the Myocardial InfarctionData Acquisition System. All such admissions in New Jersey from1987 to 2002 (231,164) were included and grouped in 4-year intervals.
Results There were no significant differences in demographiccharacteristics, coexisting conditions, or infarction site betweenpatients admitted on weekends and those admitted on weekdays.However, patients admitted on weekends were less likely to undergoinvasive cardiac procedures, especially on the first and seconddays of hospitalization (P<0.001). In the interval from 1999to 2002 (59,786 admissions), mortality at 30 days was significantlyhigher for patients admitted on weekends (12.9% vs. 12.0%, P=0.006).The difference became significant the day after admission (3.3%vs. 2.7%, P<0.001) and persisted at 1 year (1% absolute differencein mortality). The difference in mortality at 30 days remainedsignificant after adjustment for demographic characteristics,coexisting conditions, and site of infarction (hazard ratio,1.048; 95% confidence interval [CI], 1.022 to 1.076; P<0.001),but it became nonsignificant after additional adjustment forinvasive cardiac procedures (hazard ratio, 1.023; 95% CI, 0.997to 1.049; P=0.09).
Conclusions For patients with myocardial infarction, admissionon weekends is associated with higher mortality and lower useof invasive cardiac procedures. Our findings suggest that thehigher mortality on weekends is mediated in part by the lowerrate of invasive procedures, and we speculate that better accessto care on weekends could improve the outcome for patients withacute myocardial infarction.
Source Information
From the Department of Medicine, Robert Wood Johnson Medical School, Piscataway, NJ (W.J.K., Y.-H. S., A.C.W., A.E.M.); and the Department of Epidemiology, School of Public Health, University of Medicine and Dentistry of New Jersey, New Brunswick (K.D., S.W.M.). An interview with Dr. Thomas Lee on increased mortality with weekend admissions can be heard at www.nejm.org.
Address reprint requests to Dr. Kostis at the University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, 1 Robert Wood Johnson Pl., P.O. Box 19, New Brunswick, NJ 08903-0019, or at kostiswj{at}umdnj.edu.
Weekend Admission for Myocardial Infarction
Silber J. H., Altszuler H., Fitzgerald S. P., Ljung R., Köster M., Janszky I., Becker D. J., Kostis W. J., Demissie K., Moreyra A. E.
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N Engl J Med 2007;
357:85-88, Jul 5, 2007.
Correspondence
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