A recent NEJM study sheds some light on weekend hospital care:
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.
Related posts:
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- Do heart attack patients benefit from an implantable cardioverter defibrillator (ICD)?
- Next to the hospital, the next best place to have a heart attack
- Heart attack, from beginning to end
- Weekends
- Red Bull led to a heart attack
- Angioplasty in a healthy patient, and why preventive heart care is dismissed
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These studies try to use acute events that presumably have no relationship to the day of week as to their occurance. The assumption then is that any difference in outcome is the result of the care and not the patient or nature of their disease.
I can almost buy this assumption for hemorrhagic stroke, but who knows, even here there might be some temporal bias in terms of when people bleed, when they might be more hypertensive etc. Myocardial infarction has a very strong diurnal variation with both the timing as well as the severity of the disease varying throught the day. Why should it not also vary throughout the week also?
These studies try to improve care by noting that coverage on weekends is suboptimal. The methodology is good but not perfect.
“Myocardial infarction has a very strong diurnal variation with both the timing as well as the severity of the disease varying throught the day. Why should it not also vary throughout the week also?”
Because there is a biologically based 24 hour circadian rhythm. The designation of 7 consecutive days as being a week is a historical accident and has no biological basis.
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