New research suggests that patients with cardiac arrest who are admitted to hospital on a weekend are more likely to die than patients who are admitted on a weekday.
The findings were presented this week at the American Academy of Neurology Annual Meeting in Chicago.
Researchers analyzed data for more than 67,000 cases where patients were admitted to hospital for cardiac arrest, which occurs when the heart slows or stops working.
The data showed that patients who were hospitalized for cardiac arrest on a weekend were 13.4 per cent more likely to die than those hospitalized on a week day.
Researchers found that factors such as the size of the hospital, its status as a teaching facility or its location (urban or rural) did not affect the results.
The study also found that women were more likely to die than men after being admitted to hospital for cardiac arrest. As well, the average age of a cardiac arrest patient admitted to hospital dropped from 68 in the early 1990s to 66.5 a decade later.
Study author Dr. Richard M. Dubinsky, of the University of Kansas Medical Center and a fellow of the American Academy of Neurology, said in a statement: "A higher death rate among patients admitted on weekends may be due to lack of resources for treating cardiac arrest."
Dubinsky suggests that hospitals need to ensure that adequate resources are available on weekends so that all patients get the best care.
Abstract:
Weekend vs. Weekday Survival after Admission for Out of Hospital Cardiac Arrest
(OHCA)
Richard M. Dubinsky, Sue-Min Lai, Kansas City, KS
OBJECTIVE: 1) Examine differences in hospital mortality between patients admitted on weekends or weekdays after OHCA 2) Determine if survival after hospital admission after OHCA has improved over the last 15 years.
BACKGROUND: A recent study from New Jersey reported increased mortality after weekend admission for acute MI. Availability of automatic defibrillators, improved field resuscitation and newer treatments of hypoxic encephalopathy may increase survival.
DESIGN/METHODS: We analyzed the Nationwide Inpatient Sample (NIS) a 20% stratified sample of all US acute hospital admissions. Cases were identified with a primary diagnosis of cardiac arrest admitted from the Emergency Department. Comparisons were made based on admission year cohorts (1990-4, 1995-9, and 2000-4) and the Charlson index was used to control for comorbidities.
RESULTS: 67,554 admissions were identified. Mean age decreased (90-4: 67.9 + 11.9; 95-9: 67.7 + 12.3; 00-04: 66.5 + 12.5) and hospital mortality increased (44.9%, 43.1%, 48.7%, p < .0001) Weekend admissions had higher mortality than weekday (47.2% vs. 44.9%, p<. 0001). In the final logistic regression model men were less likely to die (OR=0.809, 95% CI 0.782-0.836), mortality was higher for weekend admissions (1.134,1.09-1.178), admission in 2000-4 compared to 1990-4 (1.123,1.079 1.168), but less for 1995-9 compared to 1990-4 (0.856,0.821-0.892) and increased for each one-point increase in the Charlson comorbidity score (1.20,1.186-1.214). The difference in mortality for weekend admission and for the most recent cohort remained after controlling for hospital size, teaching status, rural compared to urban, region, age, gender and comorbidities.
CONCLUSIONS/RELEVANCE: Weekend admission after OHCA has a 13.4% higher mortality than weekday admission. This may be due to lack of resources for acute treatment. The increased mortality of the most recent cohort is most likely due to improved field resuscitation allowing more patients to survive until admission.
