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Comparison of Inhospital Mortality and Frequency of Coronary Angiography on Weekend Versus Weekday Admissions in Patients With Non–ST-Segment Elevation Acute Myocardial Infarction
Patients with myocardial infarction admitted on weekends have been reported to less frequently undergo invasive angiography and experience poorer outcomes. We used the Nationwide Inpatient Sample database (2003 to 2011) to compare differences in all-cause inhospital mortality between patients admitt...
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| Published in: | The American journal of cardiology 2016-09, Vol.118 (5), p.632-634 |
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| container_title | The American journal of cardiology |
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| creator | Agrawal, Sahil Garg, Lohit Sharma, Abhishek Mohananey, Divyanshu Bhatia, Nirmanmoh Singh, Amitoj Shirani, Jamshid Dixon, Simon |
| description | Patients with myocardial infarction admitted on weekends have been reported to less frequently undergo invasive angiography and experience poorer outcomes. We used the Nationwide Inpatient Sample database (2003 to 2011) to compare differences in all-cause inhospital mortality between patients admitted on a weekend versus weekday for an acute non–ST-segment elevation myocardial infarction (NSTEMI) and to determine if rates and timing of coronary revascularization contributed to this difference. A total of 3,625,271 NSTEMI admissions were identified, of which 909,103 (25.1%) were weekend and 2,716,168 (74.9%) were weekday admissions. Admission on a weekend versus weekday was independently associated with lower rates of coronary angiography (odds ratio [OR] 0.88; 95% confidence interval [CI] 0.89 to 0.90; p |
| doi_str_mv | 10.1016/j.amjcard.2016.06.022 |
| format | article |
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We used the Nationwide Inpatient Sample database (2003 to 2011) to compare differences in all-cause inhospital mortality between patients admitted on a weekend versus weekday for an acute non–ST-segment elevation myocardial infarction (NSTEMI) and to determine if rates and timing of coronary revascularization contributed to this difference. A total of 3,625,271 NSTEMI admissions were identified, of which 909,103 (25.1%) were weekend and 2,716,168 (74.9%) were weekday admissions. Admission on a weekend versus weekday was independently associated with lower rates of coronary angiography (odds ratio [OR] 0.88; 95% confidence interval [CI] 0.89 to 0.90; p <0.001) or utilization of an early invasive strategy (EIS) (OR 0.480; 95% CI 0.47 to 0.48; p <0.001). Unadjusted inhospital mortality was significantly higher for the cohort of patients admitted on weekends (adjusted OR 1.02; 95% CI 1.01 to 1.04; p <0.001). However, this disparity was no longer significant after adjustment for differences in rates of utilization of EIS (OR 1.01; 95% CI 0.99 to 1.03; p = 0.11). In conclusion, this study demonstrates that among patients admitted with a diagnosis of an acute NSTEMI, admission on a weekend was associated with higher inhospital mortality compared with admission on a weekday and that lower rates of utilization of EIS contributed significantly to this disparity.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2016.06.022</identifier><identifier>PMID: 27381668</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute coronary syndromes ; After-Hours Care ; Aged ; Aged, 80 and over ; Cardiovascular disease ; Confidence intervals ; Coronary Angiography - adverse effects ; Coronary Angiography - mortality ; Coronary vessels ; Female ; Health care policy ; Heart attacks ; Hospital Mortality ; Hospitals ; Humans ; Length of Stay - statistics & numerical data ; Male ; Medical imaging ; Middle Aged ; Mortality ; Non-ST Elevated Myocardial Infarction - diagnosis ; Non-ST Elevated Myocardial Infarction - mortality ; Non-ST Elevated Myocardial Infarction - therapy ; Patient Admission - statistics & numerical data ; Patient Discharge - statistics & numerical data ; Patients ; Percutaneous Coronary Intervention - adverse effects ; Percutaneous Coronary Intervention - mortality ; Registries ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome ; United States - epidemiology ; Workforce planning</subject><ispartof>The American journal of cardiology, 2016-09, Vol.118 (5), p.632-634</ispartof><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Sep 1, 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c426t-7089ae6bb56d6d65818aebcff0b60745008c0c83dba420d9e6ada4106d7adc63</citedby><cites>FETCH-LOGICAL-c426t-7089ae6bb56d6d65818aebcff0b60745008c0c83dba420d9e6ada4106d7adc63</cites><orcidid>0000-0002-2075-7807</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27381668$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Agrawal, Sahil</creatorcontrib><creatorcontrib>Garg, Lohit</creatorcontrib><creatorcontrib>Sharma, Abhishek</creatorcontrib><creatorcontrib>Mohananey, Divyanshu</creatorcontrib><creatorcontrib>Bhatia, Nirmanmoh</creatorcontrib><creatorcontrib>Singh, Amitoj</creatorcontrib><creatorcontrib>Shirani, Jamshid</creatorcontrib><creatorcontrib>Dixon, Simon</creatorcontrib><title>Comparison of Inhospital Mortality and Frequency of Coronary Angiography on Weekend Versus Weekday Admissions in Patients With Non–ST-Segment Elevation Acute Myocardial Infarction</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Patients with myocardial infarction admitted on weekends have been reported to less frequently undergo invasive angiography and experience poorer outcomes. We used the Nationwide Inpatient Sample database (2003 to 2011) to compare differences in all-cause inhospital mortality between patients admitted on a weekend versus weekday for an acute non–ST-segment elevation myocardial infarction (NSTEMI) and to determine if rates and timing of coronary revascularization contributed to this difference. A total of 3,625,271 NSTEMI admissions were identified, of which 909,103 (25.1%) were weekend and 2,716,168 (74.9%) were weekday admissions. Admission on a weekend versus weekday was independently associated with lower rates of coronary angiography (odds ratio [OR] 0.88; 95% confidence interval [CI] 0.89 to 0.90; p <0.001) or utilization of an early invasive strategy (EIS) (OR 0.480; 95% CI 0.47 to 0.48; p <0.001). Unadjusted inhospital mortality was significantly higher for the cohort of patients admitted on weekends (adjusted OR 1.02; 95% CI 1.01 to 1.04; p <0.001). However, this disparity was no longer significant after adjustment for differences in rates of utilization of EIS (OR 1.01; 95% CI 0.99 to 1.03; p = 0.11). In conclusion, this study demonstrates that among patients admitted with a diagnosis of an acute NSTEMI, admission on a weekend was associated with higher inhospital mortality compared with admission on a weekday and that lower rates of utilization of EIS contributed significantly to this disparity.</description><subject>Acute coronary syndromes</subject><subject>After-Hours Care</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cardiovascular disease</subject><subject>Confidence intervals</subject><subject>Coronary Angiography - adverse effects</subject><subject>Coronary Angiography - mortality</subject><subject>Coronary vessels</subject><subject>Female</subject><subject>Health care policy</subject><subject>Heart attacks</subject><subject>Hospital Mortality</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Non-ST Elevated Myocardial Infarction - diagnosis</subject><subject>Non-ST Elevated Myocardial Infarction - mortality</subject><subject>Non-ST Elevated Myocardial Infarction - therapy</subject><subject>Patient Admission - statistics & numerical data</subject><subject>Patient Discharge - statistics & numerical data</subject><subject>Patients</subject><subject>Percutaneous Coronary Intervention - adverse effects</subject><subject>Percutaneous Coronary Intervention - mortality</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>United States - epidemiology</subject><subject>Workforce planning</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNqNks2O0zAQgCMEYsvCI4AsceGSYieOk5xQVe1CpV1A2gqOlmNPWofG7trJSr3xDvss-0I8CRNaOHABeSRrZr4Ze36S5CWjc0aZeNvNVd9pFcw8Q3VOUbLsUTJjVVmnrGb542RGKc3SmvH6LHkWY4cqY4V4mpxlZV4xIapZ8rD0_V4FG70jviUrt_Vxbwe1I9c-4GWHA1HOkMsAtyM4fZiopQ_eqXAgC7exfhPUfot2R74CfAOEv0CIY_ylGoWU6W2M1rtIrCOf1WDBDei2w5Z89O7H9_ubdXoDmx7N5GIHd0hgtoUeByDXBz9VafFHK9eqoCff8-RJq3YRXpzu82R9ebFefkivPr1fLRdXqeaZGNKSVrUC0TSFMHiKilUKGt22tBG05AWllaa6yk2jeEZNDUIZxRkVplRGi_w8eXNMuw8eq4-DxEI07HbKgR-jZBW2s-ac_Rea8bwSnCP6-i-082NwWMdEcVbTsqyRKo6UDj7GAK3cB9tj0yWjctoA2cnTBshpAyRFyTKMe3XKPjY9mD9Rv0eOwLsjANi4OwtBRo0D0WBsAD1I4-0_nvgJtBXIjA</recordid><startdate>20160901</startdate><enddate>20160901</enddate><creator>Agrawal, Sahil</creator><creator>Garg, Lohit</creator><creator>Sharma, Abhishek</creator><creator>Mohananey, Divyanshu</creator><creator>Bhatia, Nirmanmoh</creator><creator>Singh, Amitoj</creator><creator>Shirani, Jamshid</creator><creator>Dixon, Simon</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>7QO</scope><orcidid>https://orcid.org/0000-0002-2075-7807</orcidid></search><sort><creationdate>20160901</creationdate><title>Comparison of Inhospital Mortality and Frequency of Coronary Angiography on Weekend Versus Weekday Admissions in Patients With Non–ST-Segment Elevation Acute Myocardial Infarction</title><author>Agrawal, Sahil ; Garg, Lohit ; Sharma, Abhishek ; Mohananey, Divyanshu ; Bhatia, Nirmanmoh ; Singh, Amitoj ; Shirani, Jamshid ; Dixon, Simon</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c426t-7089ae6bb56d6d65818aebcff0b60745008c0c83dba420d9e6ada4106d7adc63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Acute coronary syndromes</topic><topic>After-Hours Care</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cardiovascular disease</topic><topic>Confidence intervals</topic><topic>Coronary Angiography - adverse effects</topic><topic>Coronary Angiography - mortality</topic><topic>Coronary vessels</topic><topic>Female</topic><topic>Health care policy</topic><topic>Heart attacks</topic><topic>Hospital Mortality</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Non-ST Elevated Myocardial Infarction - diagnosis</topic><topic>Non-ST Elevated Myocardial Infarction - mortality</topic><topic>Non-ST Elevated Myocardial Infarction - therapy</topic><topic>Patient Admission - statistics & numerical data</topic><topic>Patient Discharge - statistics & numerical data</topic><topic>Patients</topic><topic>Percutaneous Coronary Intervention - adverse effects</topic><topic>Percutaneous Coronary Intervention - mortality</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>United States - 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Academic</collection><collection>Biotechnology Research Abstracts</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Agrawal, Sahil</au><au>Garg, Lohit</au><au>Sharma, Abhishek</au><au>Mohananey, Divyanshu</au><au>Bhatia, Nirmanmoh</au><au>Singh, Amitoj</au><au>Shirani, Jamshid</au><au>Dixon, Simon</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of Inhospital Mortality and Frequency of Coronary Angiography on Weekend Versus Weekday Admissions in Patients With Non–ST-Segment Elevation Acute Myocardial Infarction</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2016-09-01</date><risdate>2016</risdate><volume>118</volume><issue>5</issue><spage>632</spage><epage>634</epage><pages>632-634</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>Patients with myocardial infarction admitted on weekends have been reported to less frequently undergo invasive angiography and experience poorer outcomes. We used the Nationwide Inpatient Sample database (2003 to 2011) to compare differences in all-cause inhospital mortality between patients admitted on a weekend versus weekday for an acute non–ST-segment elevation myocardial infarction (NSTEMI) and to determine if rates and timing of coronary revascularization contributed to this difference. A total of 3,625,271 NSTEMI admissions were identified, of which 909,103 (25.1%) were weekend and 2,716,168 (74.9%) were weekday admissions. Admission on a weekend versus weekday was independently associated with lower rates of coronary angiography (odds ratio [OR] 0.88; 95% confidence interval [CI] 0.89 to 0.90; p <0.001) or utilization of an early invasive strategy (EIS) (OR 0.480; 95% CI 0.47 to 0.48; p <0.001). Unadjusted inhospital mortality was significantly higher for the cohort of patients admitted on weekends (adjusted OR 1.02; 95% CI 1.01 to 1.04; p <0.001). However, this disparity was no longer significant after adjustment for differences in rates of utilization of EIS (OR 1.01; 95% CI 0.99 to 1.03; p = 0.11). In conclusion, this study demonstrates that among patients admitted with a diagnosis of an acute NSTEMI, admission on a weekend was associated with higher inhospital mortality compared with admission on a weekday and that lower rates of utilization of EIS contributed significantly to this disparity.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27381668</pmid><doi>10.1016/j.amjcard.2016.06.022</doi><tpages>3</tpages><orcidid>https://orcid.org/0000-0002-2075-7807</orcidid></addata></record> |
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| subjects | Acute coronary syndromes After-Hours Care Aged Aged, 80 and over Cardiovascular disease Confidence intervals Coronary Angiography - adverse effects Coronary Angiography - mortality Coronary vessels Female Health care policy Heart attacks Hospital Mortality Hospitals Humans Length of Stay - statistics & numerical data Male Medical imaging Middle Aged Mortality Non-ST Elevated Myocardial Infarction - diagnosis Non-ST Elevated Myocardial Infarction - mortality Non-ST Elevated Myocardial Infarction - therapy Patient Admission - statistics & numerical data Patient Discharge - statistics & numerical data Patients Percutaneous Coronary Intervention - adverse effects Percutaneous Coronary Intervention - mortality Registries Retrospective Studies Risk Assessment Risk Factors Time Factors Treatment Outcome United States - epidemiology Workforce planning |
| title | Comparison of Inhospital Mortality and Frequency of Coronary Angiography on Weekend Versus Weekday Admissions in Patients With Non–ST-Segment Elevation Acute Myocardial Infarction |
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