PMID- 28965096 OWN - NLM STAT- MEDLINE DCOM- 20180608 LR - 20220317 IS - 2044-6055 (Electronic) IS - 2044-6055 (Linking) VI - 7 IP - 9 DP - 2017 Sep 29 TI - Effect of weekend admission on process of care and clinical outcomes for the management of acute coronary syndromes: a retrospective analysis of three UK centres. PG - e016866 LID - 10.1136/bmjopen-2017-016866 [doi] LID - e016866 AB - OBJECTIVES: The effect of weekend versus weekday admission following acute coronary syndrome (ACS) on process of care and mortality remains controversial. This study aimed to investigate the 'weekend-effect' on outcomes using a multicentre dataset of patients with ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction/unstable angina (NSTEMI/UA). DESIGN: This retrospective observational study used propensity score (PS) stratification to adjust estimates of weekend effect for observed confounding. Logistic regression was used to estimate odds ratios (ORs) for binary outcomes and time-to-event endpoints were modelled using Cox proportional hazards to estimate hazard ratios (HRs). SETTING: Three tertiary cardiac centres in England and Wales that contribute to the Myocardial Ischaemia National Audit Project. PARTICIPANTS: Between January 2010 and March 2016, 17 705 admissions met the study inclusion criteria, 4327 of which were at a weekend. PRIMARY AND SECONDARY OUTCOMES: Associations were studied between weekend admissions and the following primary outcome measures: in-hospital mortality, 30-day mortality and long-term survival; secondary outcomes included several processes of care indicators, such as time to coronary angiography. RESULTS: After PS stratification adjustment, mortality outcomes were similar between weekend and weekday admission across patients with STEMI and NSTEMI/UA. Weekend admissions were less likely to be discharged within 1 day (HR 0.72, 95% CI 0.66 to 0.78), but after 4 days the length of stay was similar (HR 0.97, 95% CI 0.90 to 1.04). Fewer patients with NSTEMI/UA received angiography between 0 and 24 hours at a weekend (HR 0.71, 95% CI 0.65 to 0.77). Weekend patients with STEMI were less likely to undergo an angiogram within 1 hour, but there was no significant difference after this time point. CONCLUSION: Patients with ACS had similar mortality and processes of care when admitted on a weekend compared with a weekday. There was evidence of a delay to angiography for patients with NSTEMI/UA admitted at the weekend. CI - (c) Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. FAU - Martin, Glen P AU - Martin GP AUID- ORCID: 0000-0002-3410-9472 AD - Faculty of Biology, Medicine and Health, Farr Institute, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. FAU - Kinnaird, Tim AU - Kinnaird T AD - Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK. AD - Department of Cardiology, University Hospital of Wales, Cardiff, UK. FAU - Sperrin, Matthew AU - Sperrin M AD - Faculty of Biology, Medicine and Health, Farr Institute, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. FAU - Anderson, Richard AU - Anderson R AD - Department of Cardiology, University Hospital of Wales, Cardiff, UK. FAU - Gamal, Amr AU - Gamal A AD - Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK. FAU - Jabbar, Avais AU - Jabbar A AD - Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK. FAU - Kwok, Chun Shing AU - Kwok CS AD - Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK. AD - Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, UK. FAU - Barker, Diane AU - Barker D AD - Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, UK. FAU - Heatlie, Grant AU - Heatlie G AD - Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, UK. FAU - Zaman, Azfar G AU - Zaman AG AD - Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK. FAU - Mamas, Mamas A AU - Mamas MA AD - Faculty of Biology, Medicine and Health, Farr Institute, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. AD - Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK. AD - Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, UK. LA - eng GR - MC_PC_13042/MRC_/Medical Research Council/United Kingdom GR - MR/K006665/1/MRC_/Medical Research Council/United Kingdom PT - Journal Article PT - Multicenter Study PT - Observational Study DEP - 20170929 PL - England TA - BMJ Open JT - BMJ open JID - 101552874 SB - IM MH - Acute Coronary Syndrome/*diagnostic imaging/*mortality MH - Aged MH - Coronary Angiography MH - Female MH - Hospital Mortality/*trends MH - Humans MH - Length of Stay/*statistics & numerical data MH - Logistic Models MH - Male MH - Middle Aged MH - Patient Admission/*trends MH - Proportional Hazards Models MH - Retrospective Studies MH - Time Factors MH - United Kingdom/epidemiology PMC - PMC5640127 OTO - NOTNLM OT - coronary heart disease OT - human resource management OT - myocardial infarction COIS- Competing interests: None declared. EDAT- 2017/10/02 06:00 MHDA- 2018/06/09 06:00 PMCR- 2017/09/29 CRDT- 2017/10/02 06:00 PHST- 2017/10/02 06:00 [entrez] PHST- 2017/10/02 06:00 [pubmed] PHST- 2018/06/09 06:00 [medline] PHST- 2017/09/29 00:00 [pmc-release] AID - bmjopen-2017-016866 [pii] AID - 10.1136/bmjopen-2017-016866 [doi] PST - epublish SO - BMJ Open. 2017 Sep 29;7(9):e016866. doi: 10.1136/bmjopen-2017-016866.