Comparison of Outcomes Among Patients With Cardiogenic Shock Admitted on Weekends Versus Weekdays

https://doi.org/10.1016/j.amjcard.2020.12.061Get rights and content

Cardiogenic shock (CS) is associated with high mortality and often requires involvement of a multidisciplinary provider team to deliver timely care. Care coordination is more difficult on weekends, which may lead to a delay in care. We sought to assess the effect of weekend admissions on outcomes in patients admitted with CS. Patients admitted with CS were identified from 2005 to 2014 in the National Inpatient Sample using ICD9 code 785.51. Baseline demographics, in-hospital procedures, and outcomes were obtained and compared by day of admission. A multivariable model was used to assess the impact of weekend admission on in-hospital mortality. A total of 875,054 CS admissions were identified (age 67.4 ± 15.1 years, 40.2% female, 72.1% Caucasian), with 23% of patients being admitted on weekends. Baseline co-morbidities were similar between groups. Weekend admissions were associated with higher in-hospital mortality (40.6% vs 37.5%) and cardiac arrest (20.3% vs 18.1%, p < 0.001 for both) consistently over the study period. Use of temporary and permanent mechanical support devices and heart transplantation were slightly less common for weekend admissions. In a multivariable model adjusting for relevant confounders, weekend admission was associated with a 10% increased mortality in patients with CS. In conclusion, patients with CS admitted on weekends had higher in-hospital mortality and were slightly less likely to receive mechanical support and advanced therapies compared with those admitted on weekdays. Future studies and health system initiatives should focus on rectifying these disparities with around-the-clock multidisciplinary coordinated care for CS.

Section snippets

Methods

The National Inpatient Sample (NIS) is a publicly available database available online at https://www.distributor.hcup-us.ahrq.gov. It is a stratified sample of 20% of discharges from United States hospitals and includes almost 8 million hospital discharges per year. It represents more than 95% of the United States hospitalizations from 44 states participating in the Healthcare Cost and Utilization Project. As the NIS constitutes a random 20% sample of hospital discharges, we used the available

Results

Over the 10-year time period from 2005 through 2014, there were 875,054 total hospitalizations with a diagnosis of CS; 666,931 patients were admitted on weekdays and 208,118 were admitted on weekends. Table 1 summarizes baseline demographics and co-morbidities by weekday versus weekend admission. Mean age was 67.4 ± 15.1 years, 40.2% were women, and 72.1% were Caucasian. Patients were predominantly admitted to large (70.0%) and urban teaching (60.0%) hospitals. There were significantly more

Discussion

This study of patients in a national multi-center inpatient registry examines trends in cardiogenic shock admissions over time and associations between weekend admission and subsequent in-hospital outcomes. Using this nationwide analysis from 2005 to 2014, we identified more than 875,000 admissions with primary or secondary diagnosis of CS; mortality was 38%, but decreased over the ten-year study period. More than 40% of patients admitted on weekends died prior to hospital discharge, as

Credit Author Statement

Ahmed A. Harhash, MD: conceptualization, writing – original draft; Kevin F. Kennedy, MS: software, methodology, formal analysis; Timothy J. Fendler, MD: writing – review & editing; Taiyeb M. Khumri, MD: writing – review & editing; Michael E. Nassif, MD: writing – review & editing; Anthony Magalski: writing – review & editing; Brett W. Sperry, MD: conceptualization, methodology, writing – review & editing, visualization, supervision.

Declaration of Interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgment

none

References (18)

There are more references available in the full text version of this article.

Cited by (5)

Funding: No funding was available for this work.

Disclosures: All authors have reported no relationships relevant to the contents of this paper to disclose.

Tweet: Patients with #CardiogenicShock admitted on weekends had higher in-hospital mortality and were slightly less likely to receive mechanical support and advanced therapies compared with those admitted on weekdays.

View full text