Background: ST elevation MI is an acute event that mandates immediate intervention. Often, resources play a major role to enable prompt intervention. Our study aims to elaborate any differences that may exist between weekend and weekday outcomes at a national level.
Methods: We conducted a retrospective analysis of the Nationwide Inpatient Sample (HCUP-NIS) database. Patients with an admitting diagnosis of STEMI as identified by the corresponding International Classification of Disease (ICD-10) code for the year of 2016 were analyzed. A weighted descriptive analysis was performed to generate national estimates. Group of patients admitted over weekend were compared to those admitted over weekdays. Patients were stratified by demographic and clinical data including Charlson comorbidity index. Primary outcome was in-hospital mortality. Length of stay (LOS) and total charges were secondary outcome. Statistical analysis including linear and logistic regression analyses using STATA statistical software.
Results: During 2016, total of 155690 patients met inclusion criteria of which 29.3% were admitted over the weekend. Around 70% of them were males and this ratio was maintained between the two groups. Caucasians made up 76% followed by African Americans (AA) at 9% with there being no racial differences in groups. Mean age was 63 years in both groups. Majority of patients in both groups had medicare (28.8% vs 27.95%; p=0.10) with Southern hospitals having the most admissions at 40% with the Northeast region having the least at 17% (p=0.02). In both groups, teaching hospitals made up 65% of all admits. After adjusting for age, race, income, Charlson index, hospital location, teaching status and bedsize mortality was not significantly different between the two groups (OR 1.08, p=0.098). After adjusting, patients in the highest median income group had a 19% lower risk of dying (OR 0.81, p=0.001). Mean total charge per admission was aproximately106000USD and mean LOS was 4.1 days for both groups without any significant difference (p=0.78 & p=0.95 respectively).
Conclusions: There were no significant differences in mortality, LOS or total charge between STEMI patients being admitted over the weekend vs weekdays. Our study shows that hospitals nationwide are well equipped to handle STEMI admissions despite skeleton crews over the weekend. However, patients with higher incomes had better survival and this can be an area of future intervention to target the under-served population.