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Weekend Staffer Shortfalls Increase Hospital MI Mortality


NEW BRUNSWICK, N.J. -- A weekend admission to the hospital with a heart attack is associated with higher death rates and less use of percutaneous coronary interventions, researchers reported.

NEW BRUNSWICK, N.J., March 14 -- A weekend admission to the hospital with a heart attack is associated with higher death rates and less use of percutaneous coronary interventions, according to researchers here.

Thirty-day mortality for myocardial infarction patients admitted on the weekend to a New Jersey hospital was 0.9% worse than that for patients admitted during the week, representing nine to 10 additional deaths per 1,000 admissions per year.

Weekend patients were also one-third less likely to receive percutaneous coronary intervention (PCI) on admission than patients who arrived on weekdays, William Kostis, Ph.D., of the University of Medicine and Dentistry of New Jersey here, and colleagues, reported in the March 15 issue of the New England Journal of Medicine.

In an accompanying editorial, Donald Redelmeier, M.D., and Chaim Bell, M.D., Ph.D., of the University of Toronto, noted that even a casual observations of hospital parking lots on weekends suggest that staffing shortfalls may prevail, indicating that the intensity of medical care on weekends does not match that provided on the other five days of the week.

The researchers analyzed mortality differences for 231,164 patients admitted to percutaneous coronary intervention-equipped New Jersey hospitals on weekends and weekdays from 1987 to 2002, grouped into four-year intervals. Data came from the Myocardial Infarction Data Acquisition System.

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

The proportion of patients undergoing percutaneous coronary intervention was significantly lower for weekend admissions than for weekday admissions during the first week after admission (P

An awareness of shortfalls in weekend hospital care has implications for patients regardless of economic policy, they said, adding this advice for patients:

First, patients who feel unwell during the week should not wait to see whether they feel better during the weekend.

Second, if they are unsure of how sick they may be, they should make contact with their doctor by Friday, when staffers are more available.

Third, if patients are hit by an emergency on the weekend, they should go to the hospital. Patients who have a heart attack, for example, are far safer receiving weekend hospital care than staying at home.

"The article by Kostis et al. shows that there is a specific way to improve cardiac care in hospitals: provide better treatment for acute myocardial infarction on weekends," Drs. Redelmeier and Bell concluded.

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