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Vol. 75. Issue 9.
Pages 756-762 (September 2022)
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Vol. 75. Issue 9.
Pages 756-762 (September 2022)
Original article
The effect of weekends and public holidays on the care of acute coronary syndrome in the Spanish National Health System
Identificación y cuantificación del efecto fin de semana y festivos en la atención del síndrome coronario agudo en el Sistema Nacional de Salud
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Antonio Fernández-Ortiza,b, Marian Cristina Bas Villalobosa,b, María García-Márquezc, José Luis Bernal Sobrinoc,d, Cristina Fernández-Pérezc,e, Náyade del Prado Gonzálezc, Ana Viana Tejedora,b, Iván Núñez-Gila,b, Carlos Macaya Miguela,b, Francisco Javier Elola Somozac,
Corresponding author
fjelola@movistar.es

Corresponding author: P.o del Pintor Rosales 18, 1.o izqda., 28004 Madrid, Spain..
a Instituto Cardiovascular, Hospital Clínico Universitario San Carlos, Madrid, Spain
b Fundación Interhospitalaria de Investigación Cardiovascular, Madrid, Spain
c Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
d Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
e Servicio de Medicina Preventiva y Salud Pública, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
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Abstract
Introduction and objectives

To analyze whether admission on weekends or public holidays (WHA) influences the management (performance of angioplasty, percutaneous coronary intervention [PCI]) and outcomes (in-hospital mortality) of patients hospitalized for acute coronary syndrome in the Spanish National Health System compared with admission on weekdays.

Methods

Retrospective observational study of patients admitted for ST-segment elevation myocardial infarction (STEMI) or for non–ST-segment elevation acute coronary syndrome (NSTEACS) in hospitals of the Spanish National Health system from 2003 to 2018.

Results

A total of 438 987 episodes of STEMI and 486 565 of NSTEACS were selected, of which 28.8% and 26.1% were WHA, respectively. Risk-adjusted models showed that WHA was a risk factor for in-hospital mortality in STEMI (OR, 1.05; 95%CI,1.03-1.08; P < .001) and in NSTEACS (OR, 1.08; 95%CI, 1.05-1.12; P < .001). The rate of PCI performance in STEMI was more than 2 percentage points higher in patients admitted on weekdays from 2003 to 2011 and was similar or even lower from 2012 to 2018, with no significant changes in NSTEACS. WHA was a statistically significant risk factor for both STEMI and NSTEACS.

Conclusions

WHA can increase the risk of in-hospital death by 5% (STEMI) and 8% (NSTEACS). The persistence of the risk of higher in-hospital mortality, after adjustment for the performance of PCI and other explanatory variables, probably indicates deficiencies in management during the weekend compared with weekdays.

Keywords:
Weekend
Public holidays
Acute coronary syndrome
Acute myocardial infarction
Coronary angioplasty
Abbreviations:
NSTEACS
WHA
STEMI
PCI
Resumen
Introducción y objetivos

Analizar si el ingreso en fin de semana o festivo (IFSF), frente al ingreso en días laborables, influye en el tratamiento (angioplastia, intervención coronaria percutánea [ICP]) y los resultados (mortalidad hospitalaria) de los pacientes hospitalizados por síndrome coronario agudo en el Sistema Nacional de Salud.

Métodos

Estudio observacional retrospectivo de pacientes ingresados por infarto agudo de miocardio con elevación del segmento ST (IAMCEST) o con síndrome coronario agudo sin elevación del segmento ST (SCASEST) en los hospitales del Sistema Nacional de Salud durante el periodo 2003-2018.

Resultados

Se seleccionaron 438.987 episodios de IAMCEST y 486.565 de SCASEST, de los cuales fueron IFSF el 28,8 y el 26,1% respectivamente. El IFSF se mostraba como un factor de riesgo de mortalidad hospitalaria en los modelos ajustados por riesgo del IAMCEST (OR=1,05; IC95%, 1,03-1,08; p<0,001) y del SCASEST (OR=1,08; IC95%, 1,05-1,12; p <0,001). La tasa de ICP en el IAMCEST fue más de 2 puntos porcentuales mayor en los pacientes ingresados en días laborables durante el periodo 2003-2011 y similar o incluso más baja en 2012-2018, sin cambios significativos para el SCASEST. El IFSF se mostró como factor de riesgo estadísticamente significativo tanto para el IAMCEST como para el SCASEST.

Conclusiones

El IFSF puede aumentar el riesgo de muerte hospitalaria en un 5% (IAMCEST) y un 8% (SCASEST). La persistencia del riesgo de mayor mortalidad hospitalaria tras ajustar por la realización de ICP y las demás variables explicativas probablemente indique dficiencias en el tratamiento durante el fin de semana respecto de los días laborables.

Palabras clave:
Fin de semana
Festivo
Síndrome coronario agudo
Infarto agudo de miocardio
Angioplastia

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