LAUSR

Is it still true that hospital admission during weekend is associated with an increased risk of death? Several studies in the 1990s and early 2000s reported an excess of mortality risk for patients admitted to hospital during weekends in North America, but little information is available for European countries. We therefore decided to analyse data of 80 391 patients with an acute coronary syndrome admitted to hospitals located in Northern Italy between January 2010 and December 2014. Age and sex data were collected from discharge charts. The primary outcome of interest was in-hospital mortality. Patients, on average, were 67 years old, and 70% were men. The total in-hospital mortality was 3.05%. When all patients were analysed, we found a 13% higher risk of death (OR 1.13) in those admitted at weekends compared to weekdays. The weekend effect on mortality was found to be greater in STEMI (OR 1.11) than for NSTEMI (OR 0.88) or unstable angina (UA) (OR 1.04). Surprisingly, we found that the risk of dying in hospital during weekend admissions among men (OR 1.15) was slightly higher than that for women (OR 1.11). We also sought to determine if different age clusters were susceptible to the same risk of dying due to weekend admission: the trend of the risk of death was found to be inversely correlated with age, progressively increasing in younger subjects. As indicated in Figure 1, patients older than 75 years had a risk of dying when admitted on Saturday or Sunday similar to weekdays; whereas in youngers than 75, the risk of death was significantly higher and became even greater in the younger—under 45 years—patient group. This is a new finding, that younger heart attack patients are particularly vulnerable to excess mortality linked to weekend admissions’. We were unable to evaluate the causes of the increased mortality observed at weekends, but we can advance a few hypotheses. It is likely that delay to myocardial revascularization might play a critical role only in STEMI patients and affect their prognosis, since UA and NSTEMI patients do not seem to be at increased risk. In younger subjects, where STEMI may be the first manifestation of coronary artery disease, the lack of any cardioprotective therapy could also have exaggerated the negative effects of any delay in coronary revascularization. In conclusion, the most important and unpredicted finding is that younger acute coronary syndrome (ACS) patients still suffer from an increased mortality risk when admitted during week-end days. Efforts to correct this negative trend must be encouraged to fill the gap in standard-of-care between weekends and weekdays. Giovanni Malanchini, MD, Giulio G. Stefanini, MD, PhD, FESC, Margherita Malanchini, PhD, and Federico Lombardi, MD, FESC.