Advertisement

Weekend/Holiday Versus Weekday Hospital Discharge and Guideline Adherence (from the American Heart Association's Get With the Guidelines – Coronary Artery Disease Database)

      Most hospitals have reduced medical staff on weekends. Furthermore, a recent study on acute myocardial infarction suggested that weekend admissions were associated with higher mortality compared with weekday admissions. We sought to determine if compliance with guideline recommendations for acute coronary syndrome performance measures would be worse on weekends/holidays compared with weekdays. We utilized the American Heart Association's Get with the Guidelines (GWTG) – Coronary Artery Disease database. This study included 154,910 patients admitted to 515 various hospitals from January 14, 2000 to April 30, 2007 with acute coronary syndrome (ACS). Patients discharged on weekdays were older and were more likely to be women, have a history of atrial fibrillation, cerebral vascular accident/transient ischemic attack and chronic renal insufficiency, and present with unstable angina. Although patients discharged on the weekends/holidays were slightly less likely to receive angiotensin-converting enzyme inhibitors than those discharged on weekdays (68.3% vs 69.5%, p <0.0001), all other measures were similar, and a composite performance measure for 100% compliance was equal in both groups (81.5% vs 81.4%, p = 0.77). In conclusion, within GWTG participating hospitals, weekend/holiday staffing provides the same quality of care in ACS for discharge medications and counseling compared with full weekday staffing. However, there remain further opportunities to improve utilization of guideline-recommended therapies irrespective of discharge day.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Smaha L.A.
        The American Heart Association Get With The Guidelines program.
        Am Heart J. 2004; 148: S46-S48
        • LaBresh K.A.
        • Fonarow G.C.
        • Smith S.C.
        • Bonow R.O.
        • Smaha L.C.
        • Tyler P.A.
        • Hong Y.
        • Albright D.
        • Ellrodt A.G.
        improved treatment of hospitalized coronary artery disease patients with the Get With The Guidelines Program.
        Critical Pathways in Cardiology. 2007; 6: 98-105
        • Zeger S.L.
        • Liang K.Y.
        • Albert P.S.
        Models for longitudinal data: a generalized estimating equation approach.
        Biometrics. 1988; 44: 1049-1060
        • Angus D.C.
        • Shorr A.F.
        • White A.
        • Dremsizov T.T.
        • Schmitz R.J.
        • Kelley M.A.
        • Committee on Manpower for Pulmonary and Critical Care Societies (COMPACCS)
        Critical care delivery in the United States: distribution of services and compliance with Leapfrog recommendations.
        Crit Care Med. 2006; 34: 1016-1024
        • Kostis W.J.
        • Demissie K.
        • Marcella S.W.
        • Shao Y.H.
        • Wilson A.C.
        • Moreyra A.E.
        Myocardial Infarction Data Acquisition System (MIDAS 10) Study Group.
        N Engl J Med. 2007; 356: 1099-1109
        • Peters R.W.
        • Brooks M.M.
        • Zoble R.G.
        • Liebson P.R.
        • Seals A.A.
        Chronobiology of acute myocardial infarction: Cardiac Arrhythmia Suppression Trial (CAST) Experience.
        Am J Cardiol. 1996; 78: 1198-1201
        • Magid D.J.
        • Wang Y.
        • Herrin J.
        • McNamara R.L.
        • Bradley E.H.
        • Curtis J.P.
        • Pollack Jr, C.V.
        • French W.J.
        • Blaney M.E.
        • Krumholz H.M.
        Relationship between time of day, day of week, timeliness of reperfusion, and in-hospital mortality for patients with acute ST-segment elevation myocardial infarction.
        JAMA. 2005; 294: 803-812
        • Jneid H.
        • Fonarow G.C.
        • Cannon C.P.
        • Palacios I.F.
        • Kilic T.
        • Moukarbel G.V.
        • Maree A.O.
        • Labresh K.A.
        • Liang L.
        • Newby L.K.
        • et al.
        Impact of time of presentation on the care and outcomes of acute myocardial infarction.
        Circulation. 2008; 117: 2502-2509
        • van der Palen J.
        • Doggen C.J.
        • Beaglehole R.
        Variation in the time and day of onset of myocardial infarction and sudden death.
        N Z Med J. 1995; 108: 332-334
        • Varnava A.M.
        • Sedgwick J.E.C.
        • Deaner A.
        • Ranjadayalan K.
        • Timmis A.D.
        Restricted weekend service inappropriately delays discharge after acute myocardial infarction.
        Heart. 2002; 87: 216-219
        • Smith Jr., S.C.
        • Allen J.
        • Blair S.N.
        • Bonow R.O.
        • Brass L.M.
        • Fonarow G.C.
        • Grundy S.M.
        • Hiratzka L.
        • Jones D.
        • Krumholz H.M.
        • et al.
        AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute.
        J Am Coll Cardiol. 2006; 47: 2130-2139