• Mahek Shah, Soumya Patnaik, Brijesh Patel, Shilpkumar Arora, Nilay Patel, Sopan Lahewala, Vincent M Figueredo, Matthew W Martinez, and Larry Jacobs.
• Department of Cardiology, Lehigh Valley Hospital, Allentown, PA, United States. Electronic address: mahek.shah@lvhn.org.
• Int. J. Cardiol. 2017 Dec 15; 249: 292-300.

BackgroundIn-hospital care may be constrained during the weekend due to lesser resources. Impact on outcomes of weekend versus weekday care in congestive heart failure (HF) needs further study.MethodsAdmissions with a primary diagnosis of HF using ICD-9CM codes were studied. 22,287 HF-admissions from Einstein Medical Center (2003-2013) and 2,248,482 HF-admissions from the 2002-2012 Nationwide Inpatient Sample (NIS) were analyzed separately. Primary outcomes were 30-day HF-readmission and in-hospital mortality. Logistic regression models were used to evaluate outcomes.ResultsWeekends experienced lower rates of admission and discharge. Mondays experienced the highest admission rate and Fridays experienced the highest discharge rate. Friday was independently associated with highest 30-day HF-readmission rates (Adjusted OR 1.12, CI 1.01-1.23; p=0.02) in addition to risk factors such as African-American race, hypertension, diabetes, hyperlipidemia, end-stage renal disease and coronary artery disease. Within the NIS sample, 85,479 in-hospital deaths (3.8%) were recorded. Compared to weekdays, patients admitted over the weekend had greater comorbidities, higher incidence of acute myocardial infarction (AMI) (15.8% vs. 16.8%; p<0.01), higher Charlson-comorbidity index and underwent less procedures such as echocardiography, right heart catheterization, coronary angiography, coronary revascularization or mechanical circulatory support. Weekend HF admission predicted higher in-hospital mortality (aOR 1.07, 95%CI 1.05-1.08; p<0.01) on multivariate analysis. This relationship was applicable for teaching and non-teaching hospitals.ConclusionFriday was associated with the highest discharge and 30-day HF-readmission rate. Weekend HF admissions experienced more AMI, had greater comorbidities, received less cardiac procedures and predicted higher in-hospital mortality. Higher weekend mortality may be related to the greater degree of severity of illness among admitted patients.Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

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