AF deaths more likely on the weekend

By Sarah Guy

In-hospital mortality rates for patients who have atrial fibrillation (AF) are significantly higher on the weekend than on weekdays, show US study results.

The findings emerge from data recorded in the Nationwide Inpatient Sample (NIS) 2008, and also show that patients admitted to hospital with AF on the weekend have a significantly longer stay and lower odds of undergoing cardioversion than patients admitted during the week.

"One possible reason for such a 'weekend effect' could be differences in staffing," say Abhishek Deshmukh and co-investigators from the University of Arkansas in Little Rock. "During weekends, hospital staffing is reduced in overall quantity and in the number qualified to perform certain procedures."

They add that in many hospital settings, physicians who are not entirely familiar with the cases of individual patients are likely to provide the coverage on the weekend, and that subtle early signs of acute problems may go unnoticed until some time after admission.

A total of 86,497 discharges with AF as the primary diagnosis are recorded in the NIS 2008, report the researchers, and 16,949 are recorded as weekend admissions (from midnight on a Friday until midnight on a Sunday).

Significantly more patients admitted on a weekend died in hospital compared with those admitted during the week, at 1.1% versus 0.9%, giving an odds ratio of 1.24 after adjustment for patient and hospital characteristics, and comorbidities that may have confounded the result.

Deshmukh and colleagues also observed that AF patients admitted on the weekend underwent fewer cardioversion procedures than those hospitalized on a weekday, at 7.9% versus 16.2%, and that the time until the procedure in those who did receive it was longer among weekend patients.

These findings alone may explain, to some extent, the increased in-hospital mortality of AF patients, remarks the team.

Multivariate analysis revealed that AF patients with at least three comorbidities had the greatest likelihood of in-hospital mortality compared with factors including hospital size, length of stay, race, and whether the hospital was a teaching hospital.

The researchers believe that exploring methods that may minimize staffing differences and regionalization of care could potentially "bridge the gap" in mortality that occurs between weekend and weekday AF patients. An organized systems-based approach to care could also have a positive effect, they add.

Regardless, the study findings have "important implications for clinical care" and should be explored sooner rather than later, concludes the team.

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