PMID- 24452368
OWN - NLM
STAT- MEDLINE
DCOM- 20160304
LR  - 20220408
IS  - 1756-1833 (Electronic)
IS  - 0959-8138 (Print)
IS  - 0959-8138 (Linking)
VI  - 348
DP  - 2014 Jan 21
TI  - Off-hour presentation and outcomes in patients with acute myocardial infarction: 
      systematic review and meta-analysis.
PG  - f7393
LID - bmj.f7393 [pii]
LID - 10.1136/bmj.f7393 [doi]
LID - f7393
AB  - OBJECTIVE: To assess the association between off-hour (weekends and nights) 
      presentation, door to balloon times, and mortality in patients with acute 
      myocardial infarction. DATA SOURCES: Medline in-process and other non-indexed 
      citations, Medline, Embase, Cochrane Database of Systematic Reviews, and Scopus 
      through April 2013. STUDY SELECTION: Any study that evaluated the association 
      between time of presentation to a healthcare facility and mortality or door to 
      balloon times among patients with acute myocardial infarction was included. DATA 
      EXTRACTION: Studies' characteristics and outcomes data were extracted. Quality of 
      studies was assessed with the Newcastle-Ottawa scale. A random effect 
      meta-analysis model was applied. Heterogeneity was assessed using the Q statistic 
      and I(2). RESULTS: 48 studies with fair quality, enrolling 1,896,859 patients, 
      were included in the meta-analysis. 36 studies reported mortality outcomes for 
      1,892,424 patients with acute myocardial infarction, and 30 studies reported door 
      to balloon times for 70,534 patients with ST elevation myocardial infarction 
      (STEMI). Off-hour presentation for patients with acute myocardial infarction was 
      associated with higher short term mortality (odds ratio 1.06, 95% confidence 
      interval 1.04 to 1.09). Patients with STEMI presenting during off-hours were less 
      likely to receive percutaneous coronary intervention within 90 minutes (odds 
      ratio 0.40, 0.35 to 0.45) and had longer door to balloon time by 14.8 (95% 
      confidence interval 10.7 to 19.0) minutes. A diagnosis of STEMI and countries 
      outside North America were associated with larger increase in mortality during 
      off-hours. Differences in mortality between off-hours and regular hours have 
      increased in recent years. Analyses were associated with statistical 
      heterogeneity. CONCLUSION: This systematic review suggests that patients with 
      acute myocardial infarction presenting during off-hours have higher mortality, 
      and patients with STEMI have longer door to balloon times. Clinical performance 
      measures may need to account for differences arising from time of presentation to 
      a healthcare facility.
FAU - Sorita, Atsushi
AU  - Sorita A
AD  - Division of Preventive Medicine, Mayo Clinic, Rochester, MN, USA.
FAU - Ahmed, Adil
AU  - Ahmed A
FAU - Starr, Stephanie R
AU  - Starr SR
FAU - Thompson, Kristine M
AU  - Thompson KM
FAU - Reed, Darcy A
AU  - Reed DA
FAU - Prokop, Larry
AU  - Prokop L
FAU - Shah, Nilay D
AU  - Shah ND
FAU - Murad, M Hassan
AU  - Murad MH
FAU - Ting, Henry H
AU  - Ting HH
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20140121
PL  - England
TA  - BMJ
JT  - BMJ (Clinical research ed.)
JID - 8900488
SB  - IM
CIN - BMJ. 2014;348:f7696. PMID: 24452407
CIN - J R Coll Physicians Edinb. 2014;44(2):131-2. PMID: 24999775
MH  - Angioplasty, Balloon, Coronary/statistics & numerical data
MH  - Humans
MH  - Myocardial Infarction/*epidemiology/mortality/therapy
MH  - Patient Outcome Assessment
MH  - Time Factors
PMC - PMC3898160
COIS- Competing interests: All authors have completed the ICMJE uniform disclosure form 
      at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization 
      for the submitted work other than those listed above; no financial relationships 
      with any organizations that might have an interest in the submitted work in the 
      previous three years; no other relationships or activities that could appear to 
      have influenced the submitted work.
EDAT- 2014/01/24 06:00
MHDA- 2016/03/05 06:00
PMCR- 2014/01/21
CRDT- 2014/01/24 06:00
PHST- 2014/01/24 06:00 [entrez]
PHST- 2014/01/24 06:00 [pubmed]
PHST- 2016/03/05 06:00 [medline]
PHST- 2014/01/21 00:00 [pmc-release]
AID - bmj.f7393 [pii]
AID - sora015566 [pii]
AID - 10.1136/bmj.f7393 [doi]
PST - epublish
SO  - BMJ. 2014 Jan 21;348:f7393. doi: 10.1136/bmj.f7393.