Young heart attack patients are twice as likely to die if they are admitted to hospital during the weekend compared to a weekday, according to a study on more than 80,000 patients in Italy. “Excess deaths at weekends were reported for heart attack patients a decade ago and we wanted to see if the situation had improved,” said Giovanni Malanchini from the University of Milan. “We also looked at whether there were differences by age or sex,” said Malanchini, lead author of the study. The study included all 80,391 patients with an acute coronary syndrome admitted to a hospital in the Lombardy region of Italy for less than 20 days between January 2010 and December 2014. Patients, on average, were 67 years old, and 70 per cent were men.
A total of 2,455 patients (3 per cent) died while in hospital. When all patients were analysed, the researchers found a 13 per cent higher risk of death in those admitted at weekends compared to weekdays. “We analysed data from the Milan area, which provides some of the best treatment for heart patients in Italy. Yet even here we are not delivering the best care every day of the week,” Malanchini said. The researchers then analysed outcome according to different age cut-offs (under 45, 55, 65, 75, and over 75 years). They found that the risk of dying during a weekend admission got progressively greater as age declined. Patients under 45 had a more than two-fold risk of dying at the weekend, while the excess risk in the over-75s was just 5 per cent.
“This is a new finding, that younger heart attack patients are particularly vulnerable to the excess mortality linked to weekend admissions,” said Federico Lombardi, professor at University of Milan. Men and women were then analysed separately. The researchers found that men admitted on any day of the week with an acute coronary syndrome had a 15 per cent lower risk of death than women.
Men were more susceptible to the ‘weekend effect’, with a 15 per cent increased risk of death compared to 11 per cent for women. The observational study did not examine the reasons for the excess mortality at weekends, and the causes are likely multi-factorial, researchers said. However, they said that patients admitted at weekends may have to wait longer for reperfusion therapy to open occluded arteries and restore blood flow.
“The delay in reperfusion during weekends may be more important in younger patients,” said Malanchini. “This is usually their first acute coronary syndrome and they are not receiving aspirin, drugs to lower cholesterol (statins), or drugs to lower blood pressure (angiotensin converting enzyme inhibitors and beta-blockers). This could make them more vulnerable,” Lombardi said.