People admitted on weekends to hospital for heart attack show higher death rates compared to those entering on weekdays, perhaps because of differences in the level of care provided, U.S. researchers say.

'Patients who feel unwell during the week should not wait to see whether they feel better during the weekend.' — Journal editorial

Medical student William Kostis of the Robert Wood Johnson Medical School in Piscataway, N.J., and his colleagues looked at 231,164 patients admitted for a first heart attack in the state from 1987 to 2002.

The risk of death was about five per cent higher in the month after the attack, the team reports in Thursday's issue of the New England Journal of Medicine. In the U.S., the rate translates into several thousand people each year.

The "weekend effect" has also been identified for other conditions. A Canadian study released last week found that stroke patients admitted to hospital on weekends may be more likely to die than those admitted on weekdays.

Kostis said that for his study, the reason for the difference could be because on weekends, patients were at least one-third less likely to get fast access to procedures such as angioplasty to reopen clogged arteries or bypass, compared to on weekdays.

"Patients admitted on weekends were less likely to undergo invasive cardiac procedures than were those admitted on weekdays," the researchers wrote. "Also, the time between admission and performance of procedures was longer for patients admitted on weekend."

Hospital staff who are needed for the procedures may not be working on weekends, and the team may not be called in for borderline cases, said Dr. Steven Nissen, a cardiologist at the Cleveland Clinic in Ohio, commenting on the study.

Strategies to improve cardiac care

Part of the problem could be that patients wait until the weekend to come to hospital, but that is the wrong approach, doctors Donald Redelmeier and Chaim Bell of the University of Toronto said in a journal editorial.

"Patients who feel unwell during the week should not wait to see whether they feel better during the weekend," they wrote.

"Second, if they are unsure of how sick they may be, they should contact their doctor by Friday, when staff are more available. Third, if patients are hit by an emergency on the weekend, they should go to the hospital."

Offering premiums to staff who treat heart attacks on weekends is one strategy for improving cardiac care that has been standard in Canada for decades, they said.

But it will not solve the whole problem since long-term-care institutions often do not admit patients on weekends, leading to delays in discharge at hospital, the pair wrote.

The researchers looked at trends over four-year periods, partly to consider major advances in heart attack treatment such as new clot-busting drugs, angioplasty and stents that prop open cleared arteries.

With files from the Associated Press