Deaths higher for heart attack patients at night and weekends

January 21, 2014, British Medical Journal

Mortality is higher, and emergency treatment takes longer, for heart attack patients who arrive at hospital during the night or at weekends compared with regular hours, finds a study published in BMJ today.

The results suggest that presenting outside regular hours may lead to thousands of extra deaths every year. They also show a longer 'door to balloon time' - an emergency procedure to inflate the .

Heart attacks remain the leading cause of death worldwide. Every year, around one million people in the United States have a and 400,000 die from .

Previous studies have suggested that who present to hospital during off-hours (weekends and nights) may have higher mortality compared with regular hours, but no reviews or analyses of the evidence have been done.

So a team of researchers based at the US Mayo Clinic analysed the results of 48 studies involving 1,896,859 patients to assess the effects of off-hour presentation among heart attack patients.

The studies were carried out in the US, Canada and Europe – and differences in design and quality were taken into account to minimise bias.

Patients who presented during off-hours had a 5% relative increase in mortality (both in-hospital and 30 days after discharge) than patients who presented during regular hours, resulting in an extra 6,000 deaths every year in the US alone.

For patients diagnosed with a certain type of heart attack (known as ST elevation myocardial infarction or STEMI), the results also show a delay of nearly 15 minutes in door to balloon time for patients presenting during off-hours. This, say the authors, "could increase mortality by as much as 10-15%, assuming linearity between door to balloon time and mortality."

Although they cannot rule out differences in underlying patient characteristics, the authors say their results suggest that "increased mortality during off-hours is associated with factors that arise after presentation at hospital."

And they call for further studies to explore the variation in the quality of care by time of day, such as number of staff and their level of expertise.

In an accompanying editorial, doctors at the University of Toronto argue that, patients presenting during off-hours "experience delays in urgent care and worse outcomes, and the gap seems to be increasing over time."

They suggest healthcare managers seeking to boost their 's performance for with acute myocardial infarction "should focus on improving their off-hour care, with the goal of providing consistently high quality care 24 hours a day and seven days a week."

And they suggest future studies "should try to identify specific deficits in the care pathway during off-hours, allowing differences in outcomes to be linked to differences in processes."

Explore further: New method quickly determines if chest pain is acute coronary syndrome

More information: Off-hour presentation and outcomes in patients with acute myocardial infarction: systematic review and meta-analysis, BMJ, 2014.

Editorial: Acute myocardial infarction, BMJ, 2014.

Related Stories

New method quickly determines if chest pain is acute coronary syndrome

November 5, 2013
Researchers at Karolinska Institutet have tested a new method for quickly ruling out acute myocardial infarction or other serious acute coronary disease in emergency department patients complaining of chest pains. The method, ...

Heart attack death rates unchanged in spite of faster care at hospitals

September 4, 2013
Heart attack deaths have remained the same, even as hospital teams have gotten faster at treating heart attack patients with emergency angioplasty, according to a study in this week's New England Journal of Medicine.

Research gives better understanding of performance urgent health care providers

October 22, 2013
Every year in the Netherlands, thousands of people still die after suffering from a heart attack or stroke, caused by the blocking of one or more blood vessels. With both conditions it is imperative to restore the blood flow ...

Recommended for you

Starting periods before age of 12 linked to heightened risk of heart disease and stroke

January 15, 2018
Starting periods early—before the age of 12—is linked to a heightened risk of heart disease and stroke in later life, suggests an analysis of data from the UK Biobank study, published online in the journal Heart.

'Decorated' stem cells could offer targeted heart repair

January 10, 2018
Although cardiac stem cell therapy is a promising treatment for heart attack patients, directing the cells to the site of an injury - and getting them to stay there - remains challenging. In a new pilot study using an animal ...

Two simple tests could help to pinpoint cause of stroke

January 10, 2018
Detecting the cause of the deadliest form of stroke could be improved by a simple blood test added alongside a routine brain scan, research suggests.

Exercise is good for the heart, high blood pressure is bad—researchers find out why

January 10, 2018
When the heart is put under stress during exercise, it is considered healthy. Yet stress due to high blood pressure is bad for the heart. Why? And is this always the case? Researchers of the German Centre for Cardiovascular ...

Heart-muscle patches made with human cells improve heart attack recovery

January 10, 2018
Large, human cardiac-muscle patches created in the lab have been tested, for the first time, on large animals in a heart attack model. This clinically relevant approach showed that the patches significantly improved recovery ...

Place of residence linked to heart failure risk

January 9, 2018
Location. Location. Location.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.