Weekend heart attack patients face higher risk, study says

TRENTON, N.J. -- Heart attack patients have a slightly higher risk of death if they go to the hospital on the weekend, when they are more likely to miss or wait longer for crucial treatments, one of the largest studies of the issue finds.

Although the increased risk of death is small, roughly 5 percent higher in the month after an attack occurs, it can mean potentially thousands more deaths in the United States annually. The study indicated that weekend patients waited longer for angioplasty and other procedures, probably because of reduced staffing.

Even so, doctors say you shouldn't avoid a weekend hospital visit if you think you are having a heart attack or stroke. A delay of even an hour or two increases the chance of death or sustaining serious heart or brain damage.

The study of nearly a quarter-million first-time heart attack patients in New Jersey reflects what smaller previous studies have shown about weekend medical care. Recently published Canadian research also showed that stroke patients hospitalized on weekends had a higher chance of dying than those admitted on a weekday.

In the latest study, published in today's New England Journal of Medicine, researchers at Robert Wood Johnson Medical School in Piscataway, N.J., used a large statewide database.

They tracked 231,164 patients admitted for a first heart attack from 1987 to 2002. They looked at trends over four-year periods, partly because of major advances in heart attack treatment over that time, including new clot-busting drugs, artery-clearing angioplasty, and tiny devices called stents that prop open cleared-out arteries.

In the most recent four-year period, when care was much the same as today, patients admitted on a weekend were about 7.5 percent more likely to die within a month than those admitted on a weekday.

After adjusting for factors such as age and other medical problems, the death rate was 5 percent higher for those admitted on weekends, said William J. Kostis, a medical student who was the lead researcher.

He said the difference in outcomes was obvious by the day after admission and amounted to 1 in 100 patients each year.

Kostis said weekend patients were at least one-third less likely to get angioplasty or bypass surgery promptly, compared with weekdays. "It seems very likely to be a factor," he said.

At many hospitals, the catheterization lab where those procedures are performed is closed or has limited service hours on weekends.

In the most recent four-year span, almost 13 percent of heart attack patients admitted on weekends died within a month, compared with 12 percent admitted on weekdays.

That could mean thousands of excess deaths, since about 700,000 Americans have a first heart attack each year.

The weekend death rates were similarly higher in most of the previous time periods, too.

Dr. Kirk Garratt, director of the coronary care unit at Lenox Hill Hospital in New York, noted that when the researchers adjusted for whether patients got angioplasty or other invasive treatment, the difference in death rates fell.

He said that as cardiac care generally improved over the study's 16 years, fewer patients had severe heart attacks, and that the difference in weekend and weekday death rates in the study appears to mainly reflect whether the mild heart attack patients got angioplasty.

For more information online, visit the New England Journal of Medicine at www.nejm.org or the American Heart Association www.americanheart.org.