Stroke patients admitted to hospitals on weekends may be more likely to die
Patients admitted to hospitals for ischemic stroke on weekends had a higher risk of dying than patients admitted during the week, in a Canadian study published in Stroke: Journal of the American Heart Association.
A “weekend effect” has been previously documented when looking at other conditions such as cancer and pulmonary embolism; however, little is known of its impact on stroke death.
"What is really novel in our work beyond the discovery of the ‘weekend effect’ on ischemic stroke is the subgroup analysis in other settings/characteristics and the identification of variables associated with the ‘weekend effect,’” said Gustavo Saposnik, M.D., M.Sc., lead author of the study. “This is a large, population-based study across Canada including different facilities-rural/urban, teaching/non-teaching facilities, and small/large community.”
Researchers evaluated the impact of weekend admission on in-hospital stroke deaths in different settings based on data from all ischemic stroke hospital admissions in Canada from April 2003 to March 2004. An ischemic stroke is caused by a blood clot that blocks blood flow in an artery in or leading to the brain. It is the most common type of stroke.
Of 26,676 patients admitted to 606 hospitals, 24.8 percent were admitted on Saturdays and Sundays. Patients admitted on the weekend were on average age 75, while those admitted during the week were average age 74.
After adjusting for age, gender and other medical complications, researchers found that patients admitted on the weekend had a 14 percent higher risk of dying within seven days of admission compared to patients admitted during the week.
The “weekend effect” on deaths in the seven-day period was even greater when patients were admitted to a rural hospital versus an urban hospital and when the physician in charge was a general practitioner compared to a specialist.
The analysis didn’t define what type of specialist.
“Although the ‘weekend effect’ affected patients admitted to both rural and urban hospitals and those treated by general practitioners and specialists, the effect may be larger in patients admitted to rural hospitals and when the most responsible physician is a general practitioner,” said Saposnik, an assistant professor of medicine and director of the Stroke Research Unit Division of Neurology at the University of Toronto and a staff neurologist at St. Michael’s Hospital in Toronto.
Other factors that influence the death rate in a weekend admission were if it occurred in a non-teaching hospital or if the patient required care in the intensive care unit. Further analysis also revealed that patients admitted on the weekend also were less likely to be discharged to go home.
“This appears be an ‘unmodifiable’ risk from the patient’s side,” Saposnik said. “This seems to be a ‘natural’ phenomenon in health care, even in Canada with universal, government-funded health insurance with no co-payments. If the ‘weekend effect’ occurs in a socialized health care system, it is likely that the effect may be larger in other settings.”
Researchers said disparities in resources, expertise and health care providers working during the weekend may explain the difference.
However, Saposnik stressed that patients, relatives, health care professionals and policy makers must understand that “time is brain, so the sooner the patient seeks medical attention, the higher the chance of better outcome, no matter the day, time or living area.”
Larry B. Goldstein, M.D., chair of the Stroke Council of the American Heart Association, also emphasized the importance of seeking immediate treatment whenever a person experience, stroke symptoms.
“Although the differences in weekend admission found in this study may be real, the potential benefits of obtaining early treatment would well outweigh the risk of waiting,” Goldstein said. “Patients developing symptoms of stroke such as abrupt difficulty speaking or understanding, weakness or numbness affecting an arm or leg, and unexplained difficulty walking or with coordination need to get to a hospital organized to provide stroke care as soon as possible, regardless of the day of the week.”
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Co-authors are Akerke Baibergenova, M.D., M.P.H.; Neville Bayer, M.D. and Vladimir Hachinski, M.D., D.Sc.
The Heart and Stroke Foundation of Canada and the Canadian Institute for Heath Research funded the study.
Editor’s note: For more information on stroke, visit the American Stroke Association Web site: strokeassociation.org.
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