Comparison of Outcomes Among Patients with Cardiogenic Shock Admitted on Weekends versus Weekdays

Am J Cardiol. 2021 Jan 5:S0002-9149(20)31412-0. doi: 10.1016/j.amjcard.2020.12.061. Online ahead of print.


Cardiogenic shock (CS) is associated with high mortality and often requires involvement of a multidisciplinary provider team to deliver timely care. Care coordination is more difficult on weekends, which may lead to a delay in care. We sought to assess the effect of weekend admissions on outcomes in patients admitted with CS. Patients admitted with CS were identified from 2005-2014 in the National Inpatient Sample using ICD9 code 785.51. Baseline demographics, in-hospital procedures, and outcomes were obtained and compared by day of admission. A multivariable model was used to assess the impact of weekend admission on in-hospital mortality. A total of 875,054 CS admissions were identified (age 67.4 ± 15.1 years, 40.2% female, 72.1% Caucasian), with 23% of patients being admitted on weekends. Baseline comorbidities were similar between groups. Weekend admissions were associated with higher in-hospital mortality (40.6% vs. 37.5%) and cardiac arrest (20.3% vs. 18.1%, p<0.001 for both) consistently over the study period. Use of temporary and permanent mechanical support devices and heart transplantation were slightly less common for weekend admissions. In a multivariable model adjusting for relevant confounders, weekend admission was associated with a 10% increased mortality in patients with CS. In conclusion, patients with CS admitted on weekends had higher in-hospital mortality and were slightly less likely to receive mechanical support and advanced therapies compared to those admitted on weekdays. Future studies and health system initiatives should focus on rectifying these disparities with around-the-clock multidisciplinary coordinated care for cardiogenic shock.

PMID:33417875 | DOI:10.1016/j.amjcard.2020.12.061