PMID- 31831635
OWN - NLM
STAT- MEDLINE
DCOM- 20210915
LR  - 20210919
IS  - 2044-5423 (Electronic)
IS  - 2044-5415 (Print)
IS  - 2044-5415 (Linking)
VI  - 29
IP  - 7
DP  - 2020 Jul
TI  - The relationship between off-hours admissions for primary percutaneous coronary 
      intervention, door-to-balloon time and mortality for patients with ST-elevation 
      myocardial infarction in England: a registry-based prospective national cohort 
      study.
PG  - 541-549
LID - 10.1136/bmjqs-2019-010067 [doi]
AB  - BACKGROUND: The degree to which elevated mortality associated with weekend or 
      night-time hospital admissions reflects poorer quality of care ('off-hours 
      effect') is a contentious issue. We examined if off-hours admissions for primary 
      percutaneous coronary intervention (PPCI) were associated with higher adjusted 
      mortality and estimated the extent to which potential differences in 
      door-to-balloon (DTB) times-a key indicator of care quality for ST elevation 
      myocardial infarction (STEMI) patients-could explain this association. METHODS: 
      Nationwide registry-based prospective observational study using Myocardial 
      Ischemia National Audit Project data in England. We examined how off-hours 
      admissions and DTB times were associated with our primary outcome measure, 30-day 
      mortality, using hierarchical logistic regression models that adjusted for STEMI 
      patient risk factors. In-hospital mortality was assessed as a secondary outcome. 
      RESULTS: From 76 648 records of patients undergoing PPCI between January 2007 and 
      December 2012, we included 42 677 admissions in our analysis. Fifty-six per cent 
      of admissions for PPCI occurred during off-hours. PPCI admissions during 
      off-hours were associated with a higher likelihood of adjusted 30-day mortality 
      (OR 1.13; 95% CI 1.01 to 1.25). The median DTB time was longer for off-hours 
      admissions (45 min; IQR 30-68) than regular hours (38 min; IQR 27-58; p<0.001). 
      After adjusting for DTB time, the difference in adjusted 30-day mortality between 
      regular and off-hours admissions for PPCI was attenuated and no longer 
      statistically significant (OR 1.08; CI 0.97 to 1.20). CONCLUSION: Higher adjusted 
      mortality associated with off-hours admissions for PPCI could be partly explained 
      by differences in DTB times. Further investigations to understand the off-hours 
      effect should focus on conditions likely to be sensitive to the rapid 
      availability of services, where timeliness of care is a significant determinant 
      of outcomes.
CI  - (c) Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published 
      by BMJ.
FAU - Jayawardana, Sahan
AU  - Jayawardana S
AUID- ORCID: 0000-0001-7081-3910
AD  - Department of Health Policy, London School of Economics and Political Science, 
      London, UK.
FAU - Salas-Vega, Sebastian
AU  - Salas-Vega S
AD  - Department of Health Policy, London School of Economics and Political Science, 
      London, UK.
FAU - Cornehl, Felix
AU  - Cornehl F
AD  - Department of Health Policy, London School of Economics and Political Science, 
      London, UK.
FAU - Krumholz, Harlan M
AU  - Krumholz HM
AUID- ORCID: 0000-0003-2046-127X
AD  - Center for Outcomes & Evaluation (CORE), Yale University School of Medicine, New 
      Haven, Connecticut, USA.
FAU - Mossialos, Elias
AU  - Mossialos E
AUID- ORCID: 0000-0001-8664-9297
AD  - Department of Health Policy, London School of Economics and Political Science, 
      London, UK e.a.mossialos@lse.ac.uk.
AD  - Centre for Health Policy, The Institute of Global Health Innovation, Imperial 
      College London, London, UK.
LA  - eng
GR  - UL1 TR001863/TR/NCATS NIH HHS/United States
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20191212
PL  - England
TA  - BMJ Qual Saf
JT  - BMJ quality & safety
JID - 101546984
CIN - BMJ Qual Saf. 2020 Jul;29(7):525-527. PMID: 31874861
MH  - England
MH  - Female
MH  - Hospital Mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Myocardial Infarction
MH  - *Percutaneous Coronary Intervention
MH  - Prospective Studies
MH  - Registries
MH  - *ST Elevation Myocardial Infarction
MH  - Time Factors
MH  - Treatment Outcome
PMC - PMC7362773
OTO - NOTNLM
OT  - Duty Hours/Work hours
OT  - Health policy
OT  - Healthcare quality improvement
COIS- Competing interests: None declared.
EDAT- 2019/12/14 06:00
MHDA- 2021/09/16 06:00
PMCR- 2020/07/15
CRDT- 2019/12/14 06:00
PHST- 2019/07/11 00:00 [received]
PHST- 2019/11/15 00:00 [revised]
PHST- 2019/11/25 00:00 [accepted]
PHST- 2019/12/14 06:00 [pubmed]
PHST- 2021/09/16 06:00 [medline]
PHST- 2019/12/14 06:00 [entrez]
PHST- 2020/07/15 00:00 [pmc-release]
AID - bmjqs-2019-010067 [pii]
AID - 10.1136/bmjqs-2019-010067 [doi]
PST - ppublish
SO  - BMJ Qual Saf. 2020 Jul;29(7):541-549. doi: 10.1136/bmjqs-2019-010067. Epub 2019 
      Dec 12.