The impact of time and day on the presentation of acute coronary syndromes

Abstract

SummaryBackground: The frequency of acute myocardial infarction (AMI) peaks on Mondays and in the mornings. However, the distribution of the types of acute coronary syndromes (ACS), including unstable angina (UA), has not been systematically evaluated.Hypothesis: The distribution of the types of ACS and clinical presentations varies by time and day of admission.Methods: A retrospective cohort study was conducted in 1,946 consecutive nontransfer ACS admissions (1999)(2000)(2001)(2002)(2003)(2004) to a tertiary-care academic center to assess presenting clinical variables in patients admitted on days versus nights (6 P.M. -6 A.M.) and weekdays versus weekends (Friday 6 P.M. -Monday 6 A.M.).Results: There were fewer ACS admissions than expected on nights and weekends (p < 0.001), but the proportion of patients with ACS presenting with STelevation myocardial infarction (STEMI) is 64% higher on weekends (p < 0.001) and 31% higher on nights (p = 0.022). This increased proportion with STEMI results in a greater proportion of ACS with AMI on weekends

Hora da admissão na unidade de emergência e mortalidade hospitalar na síndrome coronária aguda

“…Those authors have concluded that, at an efficient STEMI network focused on reperfusion, mortality does not differ according to admission time. Other factors, such as circadian rhythm 13,14 and treatment outcomes 15 can also contribute to differences between the admission times.…”

Effect of Weekend Compared With Weekday Stroke Admission on Thrombolytic Use, In-Hospital Mortality, Discharge Disposition, Hospital Charges, and Length of Stay in the Nationwide Inpatient Sample Database, 2002 to 2007

“…A recent study of patients with acute coronary syndrome found that weekend patients tended to have a higher rate of ST-elevation myocardial infarction. 18 Still, that thrombolytic use is greater on the weekend than the weekday might not intuitively make sense, and this finding may be affected by the study limitations of administrative data coding for severity of stroke and accurate reporting of thrombolytic use. Further studies such as prospective stroke registries or other large nationwide hospital data sets are needed to confirm this finding.…”

Influence of Weekend Hospital Admission on Short-Term Mortality After Intracerebral Hemorrhage

“…26 We have no reason, however, to suspect that there was a higher percentage of severe ICH cases admitted on the weekend. Another possible explanation lies in the lack of uniformity that exists in the management of patients with ICH.…”