By CARLY WEEKS
Globe and Mail
February 21, 2008 at 9:21 AM EST

People who suffer a heart attack or stroke at night and on weekends are much more likely to die than those who fall ill during regular working hours, according to new research that paints a troubling picture of the varying availability of medical treatment at hospitals.

In separate studies, researchers found a substantial difference in survival rates that suggests patients who experience some medical traumas on weekdays during business hours may have access to better treatment and care.

The results send a strong message about the varying levels of care available at different times, and could have implications for hospital staffing decisions and treatment delivery.

"Such a difference theoretically shouldn't exist, because we can't plan strokes, and these are devastating events that strike us in our path," said David Liebeskind, associate neurology director of the Stroke Center at University of California, Los Angeles, and author of one of the studies.

"What it tells us is that there are areas where we can clearly improve."
One study focused on in-hospital patients who had heart attacks and found that survival rates on weekends and weeknights from 11 p.m. to 6:59 a.m. were "substantially lower," even after adjusting for different circumstances and various characteristics of patients.

Researchers also found that patients who had heart attacks were less likely to be monitored by electrocardiography at night.

The study noted that many hospitals have reduced or less-experienced staff on duty during graveyard or weekend shifts, and fewer available nurses, which could reduce the ability to quickly detect and treat patients who have heart attacks.

The study, published in the Journal of the American Medical Association yesterday, examined data from nearly 87,000 in-hospital cardiac arrest patients from 507 hospitals and medical centres.

In two other studies being presented this week at the American Heart Association's International Stroke Conference, researchers discovered that people who go to the hospital for stroke treatment at night or on weekends are more likely to die than those treated during regular business hours.

Dr. Liebeskind's study found that stroke patients admitted on weekends underwent their first medical procedure nearly one day later than people admitted during regular hours, which could contribute to the higher mortality rates.

It's the largest study that compared outcomes for weekend versus weekday hospital admissions for stroke patients and was compiled using data from the U.S. Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project.

Although the research highlights a possible deficiency in medical care and treatment during off-hours, the problem requires significantly more investigation to determine the causes and what action needs to be taken, said Andy Wielgosz, a cardiologist and epidemiologist at the Ottawa Hospital General Campus.

"This is such a politically charged subject. I think one has to be very careful before attributing any particular cause or relationship," said Dr. Wielgosz, who is also a spokesman for the Heart and Stroke Foundation of Canada. But he said the new research warrants further study and that "old practices may have to change" if patients have poorer access to life-saving medical treatment at night and on weekends.

Researchers have previously noted that survival rates can hinge greatly on the day and time a patient is admitted to the hospital, such as a study published last year in the New England Journal of Medicine that found heart attack victims admitted on the weekend had higher death rates compared to those treated during the week.

Although many businesses, schools and other institutions shut down at night and on weekends, the growing collection of research suggests that hospitals should be the exception to that rule and continue operating at full capacity during off-hours.

"It's a question of getting people to carry beepers and just making things run 24/7," Dr. Liebeskind said.
Survival rates
A U.S. study of in-hospital cardiac arrests revealed that the percentage of patients who survived to discharge was higher during day/evening hours on weekdays.

Total arrests
Day/evening 8,973 8,827 8,636 8,529 8,518 7,657 7,453
Night 4,141 4,002 4,144 4,100 3,978 3,888 3,902
SOURCE: AMERICAN MEDICAL ASSOCIATION