|
|
Background Management of acute myocardial infarction requires urgent diagnostic and therapeutic procedures, which may not be uniformly available throughout the week.
Methods We examined differences in mortality between patients admitted on weekends and those admitted on weekdays for a first acute myocardial infarction, using the Myocardial Infarction Data Acquisition System. All such admissions in New Jersey from 1987 to 2002 (231,164) were included and grouped in 4-year intervals.
Results There were no significant differences in demographic characteristics, coexisting conditions, or infarction site between patients admitted on weekends and those admitted on weekdays. However, patients admitted on weekends were less likely to undergo invasive cardiac procedures, especially on the first and second days of hospitalization (P<0.001). In the interval from 1999 to 2002 (59,786 admissions), mortality at 30 days was significantly higher 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 difference in mortality). The difference in mortality at 30 days remained significant 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 for invasive cardiac procedures (hazard ratio, 1.023; 95% CI, 0.997 to 1.049; P=0.09).
Conclusions For patients with myocardial infarction, admission on weekends is associated with higher mortality and lower use of invasive cardiac procedures. Our findings suggest that the higher mortality on weekends is mediated in part by the lower rate of invasive procedures, and we speculate that better access to care on weekends could improve the outcome for patients with acute 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.
Related Letters:
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.
Extract |
Full Text |
PDF
N Engl J Med 2007;
357:85-88, Jul 5, 2007.
Correspondence
This article has been cited by other articles:
HOME | SUBSCRIBE | SEARCH | CURRENT ISSUE | PAST ISSUES | COLLECTIONS | PRIVACY | HELP | beta.nejm.org Comments and questions? Please contact us. The New England Journal of Medicine is owned, published, and copyrighted © 2008 Massachusetts Medical Society. All rights reserved. |
Previous
Audio Interview
