Don't have a heart attack on the weekend: study

BOSTON (Reuters) - People who have heart attacks on weekends are more likely to die and get poorer care than those stricken on weekdays, U.S. researchers reported on Wednesday.

Their study, published in the New England Journal of Medicine, echoes a study published last week that made similar findings for stroke victims in Canada.

Both suggested that the aggressive, specialized care that saves lives is simply less available on a weekend.

“One in one hundred people with their first heart attack are going to die because hospital policies are not the same on the weekend as the weekday,” said William Kostis of the Robert Wood Johnson Medical School in Piscataway, New Jersey, who led the study.

“This represents several thousand people in one year,” said in a telephone interview.

For Wednesday’s study, Kostis and colleagues tracked more than 200,000 first-time heart attacks in their state.

On the day after admission, the mortality rate was 3.3 percent for those admitted on a Saturday or Sunday, compared to 2.7 percent for people brought in on a weekday. That difference in the death rate persisted for a year.

The apparent reason: treatments designed to reopen blocked arteries were less available on weekends, the researchers said.

“Patients admitted on weekends were less likely to undergo invasive cardiac procedures than were those admitted on weekdays. Also, the time between admission and performance of procedures was longer for patients admitted on weekends,” Kostis and his colleagues wrote.

“This is a practical insight that should motivate change,” Donald Redelmeier and Chaim Bell of the University of Toronto wrote in a commentary.


The lessons are clear, they said.

“First, patients who feel unwell during the week should not wait to see whether they feel better during the weekend. Second, if they are unsure of how sick they may be, they should contact their doctor by Friday, when staff are more available,” Bell and Redelmeier wrote.

“Third, if patients are hit by an emergency on the weekend, they should go to the hospital; patients who sustain a heart attack, for example, are far safer receiving weekend hospital care than staying at home.”

Kostis said hospitals should adopt the same system used in regional trauma centers, where full-time physicians, staff and services are available around the clock. In addition, rescue teams that deliver patients should be giving preference to hospitals to provide that kind of care.

“Coronary disease is the leading cause of death in the United States, not trauma, and it behooves us to give them the best care we can,” he said.

The Kostis team found that heart attack care has became increasingly available during weekends from 1987 to 2002. From 1987 to 1990 it typically took six days for doctors to get a patient into the operating room to probe the heart arteries, looking for blockages to open.

For the group of patients admitted from 1999 to 2002, the wait for cardiac catheterization was down to two days.

A 2002 report on 38 intensive care units in the United States found the death rate was 9 percent higher for people admitted on the weekend. However, that test excluded heart attack patients.