The “Weekend Effect” among patients presenting with acute coronary syndrome at the Philippine general hospital

Abstract

Introduction: Studies have shown that weekend and holiday admissions for patients with acute coronary syndrome (ACS) are associated with higher incidence of in-hospital mortality and major adverse cardiovascular events (MACE). This has been referred to as the “weekend effect.” Objectives: We aim to determine whether adults with ACS admitted on weekends have an increased risk for adverse outcomes, primarily in-hospital mortality. Methodology: This is a retrospective cohort observational study. An ACS database of a prospectively collected cohort was reviewed. Participants in this database included patients with a diagnosis of ACS who satisfied pre-defined inclusion and exclusion criteria. Clinical characteristics and admission data (weekend/holiday versus regular day admission) of all patients were collected. Outcomes of interest were in-hospital mortality, severe heart failure, and re-infarction. Analysis: Descriptive analysis was done by obtaining the mean and standard deviation of quantitative variables. Proportions and frequencies were reported for qualitative variables. For quantitative variables, T-test of two independent samples was used to determine if there is a significant difference. For categorical variables, the Z-test was used. Multiple logistic regression was also done to explore the predictors of the weekend effect. Results: A total of 175 patients were included in this study, 59 were admitted on a weekend/holiday and 116 on a regular day. The duration of symptoms prior to admission were longer among those who were admitted during the weekend (40.86±54.11 hrs vs 11.83±8.40 hrs, p=<0.0001). A weekend hospital admission was found to be an independent predictor of in-hospital mortality. Conclusion: For patients with ACS, a weekend admission was associated with increased in-hospital mortality despite similar management approach in both groups. There is a need to further explore the factors that contribute to this “weekend effect” in our setting by a prospective trial.