PMID- 31444188 OWN - NLM STAT- MEDLINE DCOM- 20200831 LR - 20200831 IS - 2044-6055 (Electronic) IS - 2044-6055 (Linking) VI - 9 IP - 8 DP - 2019 Aug 22 TI - Readmission and processes of care across weekend and weekday hospitalisation for acute myocardial infarction, heart failure or stroke: an observational study of the National Readmission Database. PG - e029667 LID - 10.1136/bmjopen-2019-029667 [doi] LID - e029667 AB - OBJECTIVES: Variation in hospital resource allocations across weekdays and weekends have led to studies of the 'weekend effect' for ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), heart failure (HF) and stroke. However, few studies have explored the 'weekend effect' on unplanned readmission. We aimed to investigate 30-day unplanned readmissions and processes of care across weekend and weekday hospitalisations for STEMI, NSTEMI, HF and stroke. DESIGN: We grouped hospitalisations for STEMI, NSTEMI, HF or stroke into weekday or weekend admissions. Multivariable adjusted ORs for binary outcomes across weekend versus weekday (reference) groups were estimated using logistic regression. SETTING: We included all non-elective hospitalisations for STEMI, NSTEMI, HF or stroke, which were recorded in the US Nationwide Readmissions Database between 2010 and 2014. PARTICIPANTS: The analysis sample included 659 906 hospitalisations for STEMI, 1 420 600 hospitalisations for NSTEMI, 3 027 699 hospitalisations for HF, and 2 574 168 hospitalisations for stroke. MAIN OUTCOME MEASURES: The primary outcome was unplanned 30-day readmission. As secondary outcomes, we considered length of stay and the following processes of care: coronary angiography, primary percutaneous coronary intervention, coronary artery bypass graft, thrombolysis, brain scan/imaging, thrombectomy, echocardiography and cardiac resynchronisation therapy/implantable cardioverter-defibrillator. RESULTS: Unplanned 30-day readmission rates were 11.0%, 15.1%, 23.0% and 10.9% for STEMI, NSTEMI, HF and stroke, respectively. Weekend hospitalisations for HF were associated with a statistically significant but modest increase in 30-day readmissions (OR of 1.045, 95% CI 1.033 to 1.058). Weekend hospitalisation for STEMI, NSTEMI or stroke was not associated with increased risk of 30-day readmission. CONCLUSION: There was no clinically meaningful evidence against the supposition that weekend and weekday hospitalisations have the same 30-day unplanned readmissions. Thirty-day readmission rates were high, especially for HF, which has implications for service provision. Strategies to reduce readmission rates should be explored, regardless of day of hospitalisation. CI - (c) Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Martin, Glen Philip AU - Martin GP AUID- ORCID: 0000-0002-3410-9472 AD - Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. FAU - Kwok, Chun Shing AU - Kwok CS AD - Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK. FAU - Van Spall, Harriette Gillian Christine AU - Van Spall HGC AD - Department of Medicine, McMaster University, Hamilton, Ontario, Canada. FAU - Volgman, Annabelle Santos AU - Volgman AS AD - Department of Cardiology, Rush University Medical Center, Chicago, Illinois, USA. FAU - Michos, Erin AU - Michos E AD - Department of Medicine (Cardiology), Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. FAU - Parwani, Purvi AU - Parwani P AD - Division of Cardiology, Loma Linda University School of Medicine, Loma Linda, California, USA. FAU - Alraies, Chadi AU - Alraies C AD - Wayne State University, Detroit Medical Center, Detroit, Michigan, USA. FAU - Thamman, Ritu AU - Thamman R AD - University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. FAU - Kontopantelis, Evangelos AU - Kontopantelis E AUID- ORCID: 0000-0001-6450-5815 AD - Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. FAU - Mamas, Mamas AU - Mamas M AD - Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK mamasmamas1@yahoo.co.uk. LA - eng PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20190822 PL - England TA - BMJ Open JT - BMJ open JID - 101552874 SB - IM MH - After-Hours Care/*statistics & numerical data MH - Aged MH - Cohort Studies MH - Coronary Angiography/statistics & numerical data MH - Coronary Artery Bypass/statistics & numerical data MH - Databases, Factual MH - Defibrillators, Implantable/statistics & numerical data MH - Echocardiography/statistics & numerical data MH - Female MH - Heart Failure/*epidemiology/therapy MH - Hospitalization/*statistics & numerical data MH - Humans MH - Length of Stay/statistics & numerical data MH - Male MH - Middle Aged MH - Non-ST Elevated Myocardial Infarction/*epidemiology/therapy MH - Patient Readmission/*statistics & numerical data MH - Percutaneous Coronary Intervention/statistics & numerical data MH - Retrospective Studies MH - ST Elevation Myocardial Infarction/*epidemiology/therapy MH - Stroke/*epidemiology/therapy MH - Thrombectomy/statistics & numerical data MH - United States/epidemiology PMC - PMC6707682 OTO - NOTNLM OT - Acute myocardial infarction OT - heartfailure OT - readmission OT - stroke OT - weekend admission OT - weekend effect COIS- Competing interests: None declared. EDAT- 2019/08/25 06:00 MHDA- 2020/09/01 06:00 PMCR- 2019/08/22 CRDT- 2019/08/25 06:00 PHST- 2019/08/25 06:00 [entrez] PHST- 2019/08/25 06:00 [pubmed] PHST- 2020/09/01 06:00 [medline] PHST- 2019/08/22 00:00 [pmc-release] AID - bmjopen-2019-029667 [pii] AID - 10.1136/bmjopen-2019-029667 [doi] PST - epublish SO - BMJ Open. 2019 Aug 22;9(8):e029667. doi: 10.1136/bmjopen-2019-029667.