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Cardiovascular medicine
Research
Readmission and processes of care across weekend and weekday hospitalisation for acute myocardial infarction, heart failure or stroke: an observational study of the National Readmission Database
  1. Glen Philip Martin1,
  2. Chun Shing Kwok2,
  3. Harriette Gillian Christine Van Spall3,
  4. Annabelle Santos Volgman4,
  5. Erin Michos5,
  6. Purvi Parwani6,
  7. Chadi Alraies7,
  8. Ritu Thamman8,
  9. Evangelos Kontopantelis1,
  10. Mamas Mamas2
  1. 1 Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
  2. 2 Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
  3. 3 Department of Medicine, McMaster University, Hamilton, Ontario, Canada
  4. 4 Department of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
  5. 5 Department of Medicine (Cardiology), Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  6. 6 Division of Cardiology, Loma Linda University School of Medicine, Loma Linda, California, USA
  7. 7 Wayne State University, Detroit Medical Center, Detroit, Michigan, USA
  8. 8 University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Prof Mamas Mamas; mamasmamas1{at}yahoo.co.uk

Abstract

Objectives Variation in hospital resource allocations across weekdays and weekends have led to studies of the ‘weekend effect’ for ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), heart failure (HF) and stroke. However, few studies have explored the ‘weekend effect’ on unplanned readmission. We aimed to investigate 30-day unplanned readmissions and processes of care across weekend and weekday hospitalisations for STEMI, NSTEMI, HF and stroke.

Design We grouped hospitalisations for STEMI, NSTEMI, HF or stroke into weekday or weekend admissions. Multivariable adjusted ORs for binary outcomes across weekend versus weekday (reference) groups were estimated using logistic regression.

Setting We included all non-elective hospitalisations for STEMI, NSTEMI, HF or stroke, which were recorded in the US Nationwide Readmissions Database between 2010 and 2014.

Participants The analysis sample included 659 906 hospitalisations for STEMI, 1 420 600 hospitalisations for NSTEMI, 3 027 699 hospitalisations for HF, and 2 574 168 hospitalisations for stroke.

Main outcome measures The primary outcome was unplanned 30-day readmission. As secondary outcomes, we considered length of stay and the following processes of care: coronary angiography, primary percutaneous coronary intervention, coronary artery bypass graft, thrombolysis, brain scan/imaging, thrombectomy, echocardiography and cardiac resynchronisation therapy/implantable cardioverter-defibrillator.

Results Unplanned 30-day readmission rates were 11.0%, 15.1%, 23.0% and 10.9% for STEMI, NSTEMI, HF and stroke, respectively. Weekend hospitalisations for HF were associated with a statistically significant but modest increase in 30-day readmissions (OR of 1.045, 95% CI 1.033 to 1.058). Weekend hospitalisation for STEMI, NSTEMI or stroke was not associated with increased risk of 30-day readmission.

Conclusion There was no clinically meaningful evidence against the supposition that weekend and weekday hospitalisations have the same 30-day unplanned readmissions. Thirty-day readmission rates were high, especially for HF, which has implications for service provision. Strategies to reduce readmission rates should be explored, regardless of day of hospitalisation.

  • Acute myocardial infarction
  • heartfailure
  • stroke
  • weekend admission
  • weekend effect
  • readmission

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-029667

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    Footnotes

    • Contributors GPM and MM made substantial contributions to the concept of the work. GPM performed the analysis and drafted the initial version of the manuscript. All named authors helped interpreted the results, revised multiple drafts of the paper critically for important intellectual content and approved the final version of the paper. All authors agree to be accountable for all aspects of the work. The corresponding author (MM) attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

    • Funding This research was partially funded by the North Staffordshire Heart Committee.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available.