Weekend care for a-fib can lead to higher mortality

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Patients admitted with atrial fibrillation (AF) on weekends had lower odds of undergoing a cardioversion procedure and greater odds of dying, according to a study published July 15 in the American Journal of Cardiology.

The outcome for conditions such as acute MI is “relatively poor” when patients are hospitalized over a weekend versus a weekday, according to the study authors, who suggested that “a likely contributing factor” is the limited number of hospital staff and availability of in-house expertise for invasive coronary procedures on the weekends. However, data on the “weekend effect” for AF-related hospitalizations and their outcomes are not available.

Because AF is the most common sustained cardiac rhythm disturbance, they pointed out, even a small difference in mortality between the weekday and weekend admissions of patients would result in a substantial number of increased deaths in the population by virtue of its high incidence.

Thus, Abhishek Deshmukh, MD, of the University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System in Little Rock, and colleagues investigated the differences in outcomes for AF-related hospitalization on the weekend versus weekdays using the Nationwide Inpatient Sample (NIS) for 2008, which is the largest all-payer database of hospital inpatient stays in the U.S. The 2008 NIS contains discharge data from 1,044 hospitals located in 40 states, approximating a 20 percent stratified sample of U.S. community hospitals.

In the database from 2008, the researchers identified a total of 86,497 discharges with a primary discharge diagnosis of AF. The use of a cardioversion procedure for AF on weekends was lower than that on a weekday (7.9 vs. 16.2 percent). After adjusting for patient and hospital characteristics and disease severity, the adjusted in-hospital mortality odds were greater for weekend admissions.  

They also found temporal changes in the length of stay, number of procedures and interval to procedure time. More specifically, patients admitted on weekends were less likely to undergo cardioversion than those admitted on weekdays. Also, the interval between admission and performance of procedures was longer for patients admitted on weekends. The authors suggested that these temporal findings may explain the increased mortality among weekend admission patients hospitalized with AF.

Deshmukh et al said that one possible reason for such a “weekend effect” could be differences in staffing. During weekends, hospital staffing is reduced in overall quantity and in the number qualified to perform certain procedures (Med Care 1998;36:1626 -1638).

In their conclusion, the study authors suggested that an organized systems-based model, as undertaken with stroke, could have a similar effect on weekend AF care, and could possibly facilitate bringing down the weekend effect on mortality and length of hospital stay among patients with AF.