Weekend hospital admission and discharge for heart failure: Association with quality of care and clinical outcomes

Horwich, Tamara B.; Hernandez, Adrian F.; Liang, Li; Albert, Nancy M.; LaBresh, Kenneth A.; Yancy, Clyde W.; Fonarow, Gregg C.; for the Get With the Guidelines Steering Committee and Hospitals,

doi:10.1016/j.ahj.2009.06.025

« Previous Next »American Heart Journal
Volume 158, Issue 3 , Pages 451-458, September 2009

Weekend hospital admission and discharge for heart failure: Association with quality of care and clinical outcomes

Tamara B. Horwich, MD MS
- Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, CA
Adrian F. Hernandez, MD MHS
- Duke Clinical Research Institute; Durham, NC
Li Liang, PhD
- Duke Clinical Research Institute; Durham, NC
Nancy M. Albert, RN PhD
- Cleveland Clinic Foundation, Cleveland OH
Kenneth A. LaBresh, MD
- Mass Pro, Waltham, MA
Clyde W. Yancy, MD
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX
Gregg C. Fonarow, MD
- Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, CA
- Reprint requests: Gregg C. Fonarow, MD, Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, 10833 LeConte Avenue, Room 47-123 CHS, Los Angeles, CA 90095-1679.
for the Get With the Guidelines Steering Committee and Hospitals

Received 8 April 2009; accepted 16 June 2009. published online 05 August 2009.

Background

Although hospital admissions during weekends have been associated with worse quality of care and worse outcomes in some but not all medical conditions, the impact of weekend versus weekday admission and discharge for heart failure (HF) has not been well studied. This study investigates the association of (1) weekend compared to weekday HF admissions and discharges with quality of care and (2) weekend versus weekday HF admissions with length of stay (LOS) and mortality in the hospital.

Methods

Data were analyzed for 81,810 HF admissions at 241 sites participating in Get With the Guidelines (GWTG)–HF from January 2005 to September 2008. The cohort was stratified by weekend versus weekday admission and discharge. Generalized estimating equations adjusted for patient and hospital characteristics and clustering.

Results

Mean age was 72 ± 14 years; left ventricular ejection fraction (LVEF) was 39±17%. Inhospital mortality was 3.0% and median LOS 4 days. Weekend admission was associated with decreased odds of LVEF documentation. Weekend discharge was associated with decreased odds of LVEF documentation and completed discharge instructions. Weekend HF admission compared to weekday admission was associated with slightly higher risk-adjusted odds of longer inhospital LOS (1.03 [1.01-1.05] and increased inhospital mortality (1.13 [1.02-1.27]).

Conclusions

Among GWTG-HF hospitals, weekend admission and discharge for HF were associated with similar quality of care in many but not all measures. Risk-adjusted LOS was slightly longer and mortality moderately higher for weekend HF admissions.