Weekend and holiday admissions for decompensated heart failure and in-hospital mortality. A cumulative effect of "nonworking" days?

Autor: Elola J; Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain. Electronic address: fjelola@movistar.es., Fernández-Pérez C; Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Medicina Preventiva, Área Sanitaria de Santiago de Compostela y Barbanza, Santiago de Compostela, A Coruña, Spain; Instituto de Investigación de Santiago, Santiago de Compostela, A Coruña, Spain., Del Prado N; Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain., Bernal JL; Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Información y control de gestión, Hospital Universitario 12 de Octubre, Madrid, Spain., Rosillo N; Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario 12 de Octubre, Madrid, Spain., Bas M; Instituto Cardiovascular, Hospital Clínico Universitario San Carlos, Madrid, Spain., Fernández-Ortiz A; Instituto Cardiovascular, Hospital Clínico Universitario San Carlos, Madrid, Spain., Barba R; Servicio de Medicina Interna, Hospital Rey Juan Carlos, Móstoles, Madrid, Spain., Carretero-Gómez J; Servicio de Medicina Interna, Hospital Universitario de Badajoz, Badajoz, Spain., Pérez-Villacastín J; Servicio de Cardiología, Hospital Clínico Universitario San Carlos, Madrid, Spain. Electronic address: https://twitter.com/@jvillacastin.
Jazyk: English; Spanish; Castilian
Zdroj: Revista espanola de cardiologia (English ed.) [Rev Esp Cardiol (Engl Ed)] 2024 Jun; Vol. 77 (6), pp. 440-447. Date of Electronic Publication: 2023 Nov 15.
DOI: 10.1016/j.rec.2023.10.003
Abstrakt: Introduction and Objectives: The aim of this study was to analyze whether nonelective admissions in patients with heart failure (HF) on nonworking days (NWD) are associated with higher in-hospital mortality.
Methods: We conducted a retrospective (2018-2019) observational study of episodes of nonelective admissions in patients aged 18 years and older discharged with a principal diagnosis of HF in acute general hospitals of the Spanish National Health System. NWD at admission were defined as Fridays after 14:00hours, Saturdays, Sundays, and national and regional holidays. In-hospital mortality was analyzed with logistic regression models. The length of NWD was considered as an independent continuous variable. Propensity score matching was used as a sensitivity analysis.
Results: We selected 235 281 episodes of nonelective HF admissions. When the NWD periods were included in the in-hospital mortality model, the increases in in-hospital mortality compared with weekday admission were as follows: 1 NWD day (OR, 1.11; 95%CI, 1.07-1.16); 2 days (OR, 1.13; 95%CI, 1.09-1.17); 3 (OR, 1.16; 95%CI, 1.05-1.27); and ≥4 days (OR, 1.20; 95%CI, 1.09-1.32). There was a statistically significant association between a linear increase in NWD and higher risk-adjusted in-hospital mortality (chi-square trend P=.0002). After propensity score matching, patients with HF admitted on NWD had higher in-hospital mortality than those admitted on weekdays (OR, 1.11; average treatment effect, 12.2% vs 11.1%; P<.001).
Conclusions: We found an association between admissions for decompensated HF on an NWD and higher in-hospital mortality. The excess mortality is likely not explained by differences in severity. In this study, the "weekend effect" tended to increase as the NWD period became longer.
(Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)
Databáze: MEDLINE
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