Basic Science, Animal Models and Preclinical Studies
Weekend Versus Weekday Admission and Clinical Outcomes in Heart Failure Patients with and Without Atrial Fibrillation - Lessons from an Asian Registry
China Medical University Hospital, Taiwan1
Purpose: We conduct this study to explore the associations of weekend and weekdays admission with the clinical events among heart failure (HF) patients with and without comorbid atrial fibrillation (AF).
In this study, we recruited 36689 HF patients who were hospitalized on weekends and 142730 HF patients who were hospitalized on weekdays. There were 9324 and 35442 patients with AF in case cohort and control cohort respectively. There are seven events that we are interested in this study, including cardiac arrest, acute respiratory failure, shock, stroke, acute kidney injury (AKI), gastrointestinal (GI) bleeding and sepsis. Cox proportional hazard regression model was applied to estimate the hazard ratio. The cumulative incidence curves were obtained by the Kaplan-Meier method and assessed by the Log-rank test.
HF patients with AF and hospitalized in weekends had the highest incidence rates of cardiac arrest (3.70 per1000 person-years), acute respiratory failure (76.9 per 1000 person-years), shock (41.9 per1000 person-years), stroke (63.5 per1000 person-years), AKI (34.0 per1000 person-years) and sepsis (63.7 per1000 person-years) among four groups. The incidence rate of GI bleeding was highest in patients with atrial fibrillation who hospitalized on weekdays. Compared to HF patients without AF and hospitalized on weekdays, those with AF hospitalized on weekends increase the risk of acute respiratory failure, AKI and sepsis by 1.05 times (95%CI=1.02,1.09), 1.05 times (95%CI=1.00,1.09) and 1.03 times (95%CI=1.00,1.07), respectively. The risk to develop acute respiratory failure, shock, stroke, AKI, GI bleeding and sepsis increases in patients with atrial fibrillation compared to patients without AF and hospitalized on weekends. The hazard ratios of seven outcomes for HF patients with AF hospitalized on weekends relative to those hospitalized on weekdays were not significant.
We affirmed that a modest yet statistical significant difference between the impact of weekday/weekend admission on acute respiratory failure and AKI among HF patients without AF. Furthermore, the influence of weekday/weekend admission on clinical outcomes among HF patients with AF did exist except for GI bleeding and sepsis.