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4 Mortality is Higher in Heart Failure Patients Discharged from Hospital on Weekends
  1. Paul Carter1,
  2. Hardeep Uppal2,
  3. Suresh Chandran3,
  4. Jaydeep Sarma4,
  5. Rahul Potluri2
  1. 1The Royal Free London NHS Foundation Trust
  2. 2ACALM Study Unit in Collaboration with Aston Medical School
  3. 3Department of Acute Medicine, North Western Deanery
  4. 4University Hospital South Manchester

Abstract

Introduction Heart failure is common and one of the top contributors to mortality in the United Kingdom. There is some highly controversial evidence to support a ‘‘weekend-effect’’ with mortality rates elevated for patients admitted or discharged from hospital on the weekend. The impact of weekend discharge on mortality rates of heart failure patients in the United Kingdom has not been previously studied though, and was the focus of this study. We did this using a large database of patients discharged with heart failure to hospitals in the North of England, UK between 2000–2013.

Methods Anonymous information on patients with heart failure was obtained from hospitals in North England, UK between 1st January 2000 and 31st March 2013. This data was analysed according to the ACALM (Algorithm for Comorbidities, Associations, Length of stay and Mortality) study protocol. ICD-10 and OPCS-4 codes were used to trace patients coded for heart failure, day of discharge, patient demographics, prevalence of comorbidites and mortality data. The impact of day of discharge on mortality in heart failure patients was analysed by Kaplan-meier survival analysis and cox regression analysis adjusted for age, gender, ethnicity and the 9 top contributors to mortality (Ischaemic Heart Disease, colon cancer, breast cancer, lung cancer, pneumonia, cerebrovascular disease, Chonic Obstructive Pulmonary Disease and dementia). P values of <0.05 were taken as statistically significant.

Results Of 929552 patients admitted during the study period there were 31760 patients with heart failure. 27944 (88.8%) of patients were discharged on weekdays and 3816 (11.2%) were discharged on weekends. Demographics for patients discharged on weekdays (mean age 74 ± 14 and 50.3% male) was similar to those discharged on weekends (74 ± 14 and 50.1% male). Similarly, prevalence of the 9 top contributing conditions to mortality in the UK were similar in both groups (see Table 1). Crude all-cause mortality for heart failure patients discharged on weekends (69.2%) was higher than those discharged on weekdays (66.0%). Mortality was statistically greater for heart failure patients discharged on weekends after cox regression analysis accounting for differences in age, gender, ethnicity and the top contributors to mortality (OR 1.270, 95% confidence intervals 1.219–1.323). Kaplan-Meier survival analysis demonstrated that although 5-year survival for heart failure patients discharged on Monday-Friday were similar, survival for those discharged on Saturday/Sunday was greatly reduced.

Abstract 4 Table 1

Demographics of heart failure patients discharged on weekdays and weekends

Conclusions We have demonstrated that long-term mortality of heart failure patients discharged on weekends is significantly higher than those discharged on weekdays. Further research is required to elucidate the reasons for these disparities and could relate to premature discharge or lack of community care for heart failure patients discharged on weekends.

Abstract 4 Table 2

Prevalence of top contributors to mortality amongst heart failure patients discharged on weekdays and weekends

Abstract 4 Figure 1

5 year survival depending on day of discharge

  • Heart Failure
  • Weekend Discharge
  • Mortality

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