Abstract 12932: Day of the Week and Acute Heart Failure Admissions: Relation With Acute Myocardial Infarction, Length of Stay and Readmission Rate
Background: The day of the week has been inconsistently linked to the length of hospital stay (LOS) and even mortality in patients with heart failure (HF). With Medicare expenditure for HF hospitalizations exceeding 17 billion USD a year, there has been an increased focus on measures that could decrease HF readmissions. While reduced physician staffing, poor quality of care and lesser supervision may be seen on weekends, its role in predicting a worse outcome is unclear.
Methods: All patients with HF as the admitting diagnosis between 1/1/2003 and 12/31/2013 were included. The admissions were stratified based on the day of admission and an association with outcomes as LOS, new acute myocardial infarction (AMI) or readmission for HF was analyzed.
Results: From the 22,287 admissions included, 4,874 (22%) were on the weekend. The average age (69+/-15 years in both groups, p=0.98) and risk factors as hypertension, diabetes, hyperlipidemia, chronic kidney disease and coronary artery disease were similar between weekend and weekday admissions. More male admissions were seen on weekdays (48% vs. 46%, p=0.034) and the patients admitted on weekends experienced 25% more AMIs (p=0.005). The mean daily admission rate was significantly higher on weekdays (6.1+/-0.8/day vs. 4.2+/-0.6/day, p<0.001) with Monday and Sunday having the highest and lowest rates (6.58/day vs. 4.23/day respectively). There were lesser patient discharges on weekends than weekdays (13% vs. 87%). The LOS was similar for weekday and weekend admissions (5.7+/-6.1 vs. 5.5+/-5.8 days, p=0.125) but Friday was associated with the longest stay in the week (6+/-6.1 days vs. 5.6+/-6 days, p=0.001). The maximum and minimum 30 day readmission rate was seen in patients who were discharged on Friday and Saturday respectively with 18% more readmissions in those discharged on Friday compared to Saturday.
Conclusions: Weekends may see lesser HF admissions than weekdays but the risk of an AMI is higher in these patients. Friday admissions were associated with the maximum LOS and Friday discharges with the highest readmission rate. A better understanding of the hurdles faced during weekends with directed research and subsequent remediation of the issues can potentially improve HF care and related clinical outcomes.
Author Disclosures: M. Shah: None. S. Patnaik: None. C. Davila: None. M. Lu: None. P. Junpaparp: None. S. Buppajarnthum: None. T. De Venecia: None. A. Chandorkar: None.
- © 2014 by American Heart Association, Inc.