17 Jun Weekend-Admitted Patients With Non-STEMI Heart Attacks Have Longer Admissions and Higher Mortality
MedicalResearch.com Interview with:
Sahil Agrawal MD, MD
Heart and Vascular Center
St. Luke’s University Health Network
Bethlehem, PA 18015
MedicalResearch.com: What is the background for this study?
Dr. Agrawal: Patients admitted on a weekend have previously been known to have poorer outcomes compared to patients admitted on weekdays for various acute illnesses. With the advent of early fibrinolytic therapy and subsequently, emergent primary percutaneous coronary interventions (PCI), such discrepancies in outcomes have been largely resolved for ST-segment elevation myocardial infarctions (STEMI). In contrast, treatment of non-ST segment elevation myocardial infarction (NSTEMI) has remained less stringent such that invasive coronary angiography and potential intervention is often delayed for those presenting on a weekend rather than a week day. According to current ACC/AHA guidelines for NSTEMI, an early invasive strategy (EIS) is the preferred method of management unless barred by presence of contraindications (comorbid conditions) or patients’ preference. We were interested in investigating differences in utilization of EIS between patients admitted on a weekend versus those admitted on a weekday for an NSTEMI, and to evaluate the impact of such differences on in-hospital mortality in such patients.
MedicalResearch.com: What are the main findings?
Dr. Agrawal: Our main finding was a higher in-hospital mortality in the group of NSTEMI patients admitted on a weekend compared to those admitted on a weekday. We also showed that a lower utilization of guideline-supported early invasive strategy contributed significantly to this disparity. Further, patients admitted on a weekend experienced had a longer hospital stay.
MedicalResearch.com: What should readers take away from your report?
Dr. Agrawal: Efforts must be made to implement changes in health care policies such that adequate resources are made available in the cardiac catheterization laboratory on the weekends so that not only STEMI but also NSTEMI patients admitted on a weekend could derive benefit from early revascularization. Inclusion of NSTEMI management in quality metrics and development of registries may help achievement of such goals. Due to the high prevalence of NSTEMI such measures may have a great overall impact.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Agrawal: Future studies could investigate the economic impact of establishing early invasive strategy programs for timely diagnosis and intervention in NSTEMI patients presenting over the weekend. It would be of interest to then compare the upfront cost of such strategies against the benefits achieved in regards to shorter length of stay, better cardiac function at discharge and days of life saved.
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Comparison of In-Hospital Mortality and Frequency of Coronary Angiography on Weekend versus Week Day Admissions in Patients with Non-ST-Segment Elevation Acute Myocardial Infarction
Agrawal, Sahil et al.
American Journal of Cardiology , Volume 0 , Issue 0 ,
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Last Updated on June 17, 2016 by Marie Benz MD FAAD