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Eur Heart J Acute Cardiovasc Care. 2019 Aug;8(5):432-442. doi: 10.1177/2048872618762634. Epub 2018 Mar 2.

Weekend effect in acute coronary syndrome: A meta-analysis of observational studies.

Author information

1
1 Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK.
2
2 Royal Stoke University Hospital, Stoke-on-Trent, UK.
3
3 Al-Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia.
4
4 University Hospital of Wales, Cardiff, UK.
5
5 Freeman Hospital, Newcastle University, Newcastle, UK.
6
6 James Paget University Hospital, Great Yarmouth, UK.
7
7 Barts and London School of Medicine and Dentistry, London, UK.

Abstract

BACKGROUND:

The effect of a weekend compared with a weekday hospital admission on patient outcomes after an acute coronary syndrome is unclear. This study aims to determine whether collectively there is a weekend effect in acute coronary syndrome.

METHOD:

We conducted a systematic review and meta-analysis of cohort studies examining the association between weekend compared to weekday admission at any time of the day and early mortality (in-hospital or 30-day). A search was performed on Medline and Embase and relevant studies were pooled using random effects meta-analysis for risk of early mortality. Additional analyses were performed considering only more recent studies (conducted after 2005) and by patient group (ST-elevation myocardial infarction [STEMI] or non-STEMI [NSTEMI]), as well as meta-regression according to starting year and mean year of study.

RESULTS:

A total of 18 studies were included with over 14 million participants incorporating 3 million weekend and over 11.5 million weekday admissions and the rates of mortality were 19.2% and 23.4%, respectively. The pooled results of all 18 studies suggest that weekend admission was associated with a small increased risk of early mortality (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.03-1.09). The results for subgroups of STEMI and NSTEMI cohorts were not statistically significant and timing of admission after 2005 had minimal influence on the results (OR 1.06, 95% CI 0.95-1.17).

CONCLUSIONS:

There is a small weekend effect for admission with acute coronary syndrome that has persisted over time.

KEYWORDS:

Acute coronary syndrome; meta-analysis; mortality; weekend

PMID:
29498538
DOI:
10.1177/2048872618762634

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