
BCS Conference 2017
AbstractTitle: MORTALITY IS HIGHER IN HEART FAILURE PATIENTS DISCHARGED FROM HOSPITAL ON WEEKENDS
Submission Date : 01/12/2015 23:56:33
Category: Heart Failure
KeyWords
Heart Failure, Weekend Discharge, Mortality
Abstract Body
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 31stMarch 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). 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.
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.
Submitter Details
Dr Paul Carter
Authors
Names |
Presenting Author |
Institution |
Dr Paul Carter |
Yes |
The Royal Free London NHS Foundation Trust |
Dr Hardeep Uppal |
No |
ACALM Study Unit in collaboration with Aston Medical School |
Dr Suresh Chandran |
No |
Department of Acute Medicine, North Western Deanery |
Dr Jaydeep Sarma |
No |
University Hospital South Manchester |
Dr Rahul Potluri |
No |
ACALM Study Unit in collaboration with Aston Medical School |
|