Heart attack patients are more likely to survive if admitted to hospital on a weekday than at the weekend, because they have more access to specialist staff and essential invasive cardiac procedures.
These are the findings of a US study by scientists at the Robert Wood Johnson Foundation in New Jersey and published in the New England Journal of Medicine.
Succesful treatment of heart attack relies on speedy diagnosis and treatment, and previous studies looking at cancer and strokes have suggested this may not be available evenly over the seven days of the week.
This study reviewed 231,164 cases of people who had their first myocardial infarction (heart attack) in New Jersey between 1987 and 2002. The cases were analysed in sets of 4 yearly intervals: 1987 to 1990, 1991 to 1994, etc.
The researchers looked at differences in death rate between those cases where patients were admitted to hospital on weekdays and those where the patients were admitted on a Saturday or Sunday.
They found no differences in demographic attributes, coexisting medical conditions and other variables between patients taken into hospital over the weekend as opposed to during the week.
But they did find that weekend admissions were less likely to receive invasive cardiac procedures such as angioplasty to unblock blood vessels, particularly on the first and second day in hospital.
They also found, for example, that in the period 1999 to 2002, when nearly 60,000 patients were admitted to hospital in New Jersey with their first heart attack, significantly more weekend admitted patients died within 30 days than those admitted on a weekday.
The difference was nearly 1 per cent more deaths within 30 days in the weekend admission group (12.9 versus 12.0 per cent).
They found the difference became significant the day after admission, and was still there, at 1 per cent absolute difference in mortality one year after admission.
The researchers say this 1 per cent increase in mortality “could account for several thousand deaths annually in the United States”.
After taking into account demographics, coexisting medical conditions and site of infarction, the statistical difference in the 30 day mortality remained between the weekend and weekday admissions.
However, they found that when they factored in invasive cardiac procedures, they became non-significant, suggesting that the increase in mortality of weekend admissions is linked to the lower use of invasive cardiac procedure during the weekend.
The authors conclude that “we speculate that better access to care on weekends could improve the outcome for patients with acute myocardial infarction”.
In an editorial accompanying the article, two practising doctors agree that ensuring more care is available at the weekends is one solution. This would probably mean doctors and nurses being paid more to work at the weekends, they say.
Another solution would be to provide specialist emergency centres for heart attacks. It makes sense to do this, in the same way as road accident and crime victims are given specialist care in emergency centres, so should patients afflicted by America’s number one killer, they say.
This study follows hot on the heels of a Canadian study published earlier this month in Stroke: Journal of the American Heart Association that showed stroke patients were also more likely to die if admitted to hospital on a weekend day as opposed to a weekday.
The authors of that study also suggested unequal distribution of expertise, resources and staff between weekday and weekend as a possible explanation.
And they commented “This seems to be a ‘natural’ phenomenon in health care”, even in countries with “universal, government-funded health insurance with no co-payments”.
However, both the research team and others who commented on the study emphasized that time was the highest priority and outweighed the risk of waiting. Better to get the patient into the right hospital quickly, regardless of whether it is a weekend or weekday, than delay any diagnosis and treatment care that is available.
A heart attack, or myocardial infarction is when the blood supply to muscles of the heart itself stops or is blocked (as opposed to the blood that is being pumped by the heart to other parts of the body).
The most common cause is fat deposits called plaque that build up in arteries making them narrower (atherosclerosis). The plaque then ruptures, creating an interruption in the smoothness of the artery walls and causes blood to clot around the “snag”. This is known as a thrombosis or occlusion.
The thrombosis blocks the blood flow to the heart muscle which is then deprived of the oxygen it needs to do its job of supplying blood and oxygen to the rest of the body. The heart muscle – the myocardium – becomes infarcted (deprived of blood and oxygen) and stops pumping, in other words, becomes a heart attack.
If the heart muscle is deprived of oxygen for more than a few minutes, it can die (necrosis). If a lot of heart muscle is affected, the patient is at very high risk of dying unless specialist, and usually invasive, treatment is at hand to restore the blood flow to the heart.
According to the Women’s Heart Foundation, a person suffers a heart attack ever 20 seconds in the US, and every third victim dies. There are over 1.5 million heart attacks a year in the US, and half of heart attack deaths occur within one hour of the attack (outside of hospital).
“Weekend versus Weekday Admission and Mortality from Myocardial Infarction.”
William J. Kostis, Kitaw Demissie, Stephen W. Marcella, Yu-Hsuan Shao, Alan C. Wilson, Abel E. Moreyra.
NEJM Volume 356:1099-1109, March 15, 2007, Number 11
Written by: Catharine Paddock
Writer: Medical News Today