Weekend admission is bad for patients with heart attack

It's been clear for some time that mortality from heart attack is slightly but significantly higher for patients admitted to hospital at weekends. A new study suggests that in the US at least, the difference is partly explained by poorer access to invasive procedures such as percutaneous coronary intervention.

The researchers studied more than 200 000 men and women who were treated for heart attack in New Jersey hospitals between 1987 and 2002. People admitted at the weekends were about half as likely to have an early cardiac catheterisation (adjusted odds ratio 0.52; 95% CI 0.50 to 0.54) and about 40% less likely to have early percutaneous coronary intervention (0.62; 0.59 to 0.65) than patients admitted during the week. They also waited longer for treatment. As expected, the researchers also found that weekend admission was associated with higher mortality, but the association became weaker and insignificant once they accounted for the poor access to interventional treatments.

The authors estimate that for patients with heart attack, the excess mortality associated with weekends represents an extra 9 or 10 deaths per 1000 admissions each year. Structural reorganisation of services could prevent some of them.