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Off-peak MI admissions have worse outcomes, researchers say

Saturday January 25, 2014
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Mortality is higher and emergency treatment takes longer for patients with myocardial infarction who arrive at the hospital during the night or on weekends, compared with regular hours, according to a study.

Mayo Clinic researchers analyzed results of 48 studies published between 2001 and 2013 involving 1.8 million patients in the U.S., Europe and Canada to assess the effect of off-hour hospital arrival for MI patients.

Patients who arrived at the hospital during off-hours were 5% more likely to die — both while in the hospital and 30 days after discharge — than patients who arrived at the hospital during regular daily hours. This resulted in an extra 6,000 deaths each year in the U.S. alone.

“The results show us that there are opportunities for us to improve care during the off-hours,” Atsushi Sorita, MD, the study's first author and a senior fellow in preventive medicine at Mayo Clinic, said in a news release.

“Our research suggests that patients with acute myocardial infarction admitted during off-hours have worse outcomes after adjusting for clinical risk,” Henry Ting, MD, a Mayo Clinic cardiologist and the study’s senior author, said in the news release. “Understanding the factors that contribute to these vulnerabilities in our systems of care and staffing models during off-hours can potentially save thousands of lives.”

Although they did not rule out differences in underlying patient characteristics, the authors said their results suggest “increased mortality during off-hours is associated with factors that arise after presentation at hospital.” They call for further studies to explore the variation in the quality of care by time of day, such as number of staff and their level of expertise.

In an accompanying editorial, physicians at the University of Toronto argue that patients presenting during off-hours “experience delays in urgent care and worse outcomes, and the gap seems to be increasing over time.”

They suggest healthcare managers seeking to boost their hospital’s performance for patients with acute MI “should focus on improving their off-hour care, with the goal of providing consistently high quality care 24 hours a day and seven days a week.”

And they suggest future studies “should try to identify specific deficits in the care pathway during off-hours, allowing differences in outcomes to be linked to differences in processes.”

The study authors offer caution to people who develop signs of a MI, such as chest pain or shortness of breath: The best action is to call 911 immediately, regardless of time of day or day of the week. The difference in risk of death between off-hours and regular hours does not warrant waiting in any circumstances, Sorita said.

Study: http://www.bmj.com/content/348/bmj.f7393


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