A paper by Nanchal et al presented interesting data about the existence of a “weekend effect” for pulmonary embolism. Patients admitted to the hospital on weekend, in fact, had a 19% increased risk of death. These results represent further confirmation to previous reports in Canada (cited by the authors) and in the Emilia-Romagna region of Italy from our group, that both found a 17% increased risk of death too. We have extensively explored the possible presence of a different mortality rate between weedays and weekends, and confirmed an even more increased risk of death also for other acute cardiovascular diseases, i.e. acute heart failure (OR 1.33), and aortic aneurysm rupture or dissection (OR 1.31). Medical and nursing understaffing, shortage of diagnostic or procedural services, presence of inesperienced residents have been called as possible causes. However, the data collected in Italy (and in the Emilia-Romagna region in particular) do not support such interpretation, being also the global health system and the hospital service organization in Italy not comparable at all with that of countries like USA or UK. Temporal aspects of onset of acute cardiovascular and cerebrovascular diseases might play a role as well, and circadian and seasonal preferred times of onset of certain diseases are known. It is possible that acute diseases do not present with equal severity along time, i.e., day of the week or hour of day. A single center study on acute coronary syndromes (ACS), addressed to explore this possibility, showed that, although there were fewer ACS admissions than expected on nights and weekends, the proportion of patients with ACS presenting with ST-elevation myocardial infarctions was 64% higher on weekends. A higher severity might be linked with higher risk of mortality, and several parameters of severity collected by Nanchal et al (1), e.g., need for mechanical ventilation, thrombolytic therapy use, or use of vasopressors, are in agreement with this line. Further studies are needed to explore this intriguing relationship between time of presentation and clinical outcome of acute cardiovascular diseases.
Weekend Effect for Pulmonary Embolism and Other Acute Cardiovascular Diseases
MANFREDINI, Roberto;
2013
Abstract
A paper by Nanchal et al presented interesting data about the existence of a “weekend effect” for pulmonary embolism. Patients admitted to the hospital on weekend, in fact, had a 19% increased risk of death. These results represent further confirmation to previous reports in Canada (cited by the authors) and in the Emilia-Romagna region of Italy from our group, that both found a 17% increased risk of death too. We have extensively explored the possible presence of a different mortality rate between weedays and weekends, and confirmed an even more increased risk of death also for other acute cardiovascular diseases, i.e. acute heart failure (OR 1.33), and aortic aneurysm rupture or dissection (OR 1.31). Medical and nursing understaffing, shortage of diagnostic or procedural services, presence of inesperienced residents have been called as possible causes. However, the data collected in Italy (and in the Emilia-Romagna region in particular) do not support such interpretation, being also the global health system and the hospital service organization in Italy not comparable at all with that of countries like USA or UK. Temporal aspects of onset of acute cardiovascular and cerebrovascular diseases might play a role as well, and circadian and seasonal preferred times of onset of certain diseases are known. It is possible that acute diseases do not present with equal severity along time, i.e., day of the week or hour of day. A single center study on acute coronary syndromes (ACS), addressed to explore this possibility, showed that, although there were fewer ACS admissions than expected on nights and weekends, the proportion of patients with ACS presenting with ST-elevation myocardial infarctions was 64% higher on weekends. A higher severity might be linked with higher risk of mortality, and several parameters of severity collected by Nanchal et al (1), e.g., need for mechanical ventilation, thrombolytic therapy use, or use of vasopressors, are in agreement with this line. Further studies are needed to explore this intriguing relationship between time of presentation and clinical outcome of acute cardiovascular diseases.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
