Prognosis and treatment in patients admitted with acute myocardial infarction on weekends and weekdays from 1997 to 2009 |
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Authors: | Kim Wadt Hansen Anders Hvelplund Steen Zabell Abildstrøm Eva Prescott Mette Madsen Jan Kyst Madsen Jan Skov Jensen Rikke Sørensen Søren Galatius |
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Institution: | 1. Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark;2. Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark;3. Department of Public Health, University of Copenhagen, Copenhagen, Denmark;4. National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark;5. Danish Heart Registry, Denmark;6. Clinical Institute of Surgery and Internal Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark |
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Abstract: | BackgroundLess invasive treatment and poorer outcomes have been shown among patients admitted with acute myocardial infarction (AMI) on weekends compared to weekdays.ObjectivesTo investigate the ‘weekend-effect’ on mortality in patients with AMI.MethodsUsing nationwide registers we identified 92,164 patients aged 30–90 years who were admitted to a Danish hospital with a first AMI from 1997 to 2009. Patients were stratified according to weekday- or weekend admissions and four time-periods to investigate for temporal changes. All-cause mortality at 2, 7, 30, and 365 days was investigated using proportional hazards Cox regression.ResultsMortality rates were higher on weekends within seven days of admission in 1997–99 (absolute difference ranging from 0.8 to 1.1%). Weekend–weekday hazard-ratios were 1.13 (1.03–1.23) at day 2 and 1.10 (1.01–1.18) at day 7. There were no significant differences in 2000–09 and estimates suggested an attenuation of the initial ‘weekend-effect’.Overall, the use of coronary angiography (34.9% vs. 72.3%) and percutaneous coronary intervention (6.6% vs. 51.0%) within 30 days increased, as did the use of statins (49.9% vs. 80.1%.) and clopidogrel (26.7% vs. 72.7%). The cumulative mortality decreased during the study period from 5.4% to 2.5% at day of admission, from 19.5% to 11.0% at day 30 and from 28.0% to 19.0% at day 365 (all tests for trend p < 0.0001).ConclusionsNo persistent ‘weekend-effect’ on mortality was present in patients with AMI in 1997–2009. Overall, mortality rates have decreased concomitantly with an increased use of current guideline-recommended invasive and medical therapy. |
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Keywords: | CAPTIM Comparison of primary Angioplasty and Prehospital Fibrinolysis in Acute Myocardial Infarction DANAMI-2 Danish Trial in Acute Myocardial Infarction-2 FRISC-II Fast Revascularisation during InStability in Coronary artery disease II MONICA Monitoring Trends and Determinants in Cardiovascular Disease project PRAGUE 1 and 2 Primary Angioplasty Versus Fibrinolysis in Acute Myocardial Infarction 1 and 2 RITA-3 the third Randomized Intervention Trial of unstable Angina TACTICS-TIMI 18 Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis In Myocardial Infarction 18 |
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