Patients suffering from the most common form of heart rhythm disorder who are admitted to NHS hospital over the weekend face a higher risk of dying over the next five years than those admitted during normal hours. The new research was led by Dr Rahul Potluri, founder of the ACALM study unit at Aston University and will be presented at the British Cardiovascular Society (BCS) Conference 6-8 June.
The study of 42,687 patients with atrial fibrillation (AF)1, one of the most common forms of abnormal heart rhythm, finds that those admitted outside of normal operating hours (9am-5pm, Monday-Friday) have a 12 per cent increased risk of dying in the next five years. The research was adjusted to account for external factors which could influence death rates, such as age, gender, ethnic group, and the most common causes of mortality in the UK.
In a separate study, the researchers also looked at 31,760 heart failure2 patients discharged from hospitals in the north of England at weekends, finding a 27 per cent increased chance of dying over the next 5 years compared to those sent home during regular weekday hours.
Dr Rahul Potluri, Clinical Lecturer at Aston University’s Medical School, said, “This study shows that the weekend effect is very much a reality for those suffering two of the most prevalent heart conditions in the UK. These patients are, quite simply, more likely to die if admitted or discharged outside regular hours, and that trend is particularly noticeable at the weekend.
“We need to be clear about this because there are a lot of competing claims out there, especially where the reliability of data is concerned. Let’s get one thing straight: nobody can distort dates of admission, discharge and death. Reliability issues are inherent to the entire dataset, and there’s nothing specific to weekend data that means it should be treated differently.”
Dr Paul Carter, presenting author at the BCS Conference, said, “We took steps during this study to ensure that the comparison between the two groups was as fair as possible. It’s not simply the case that patients who come in out-of-hours are sicker than those treated during the week as some have suggested.
“What’s more, both out-of-hours admission and discharge confer an increased risk to patient health over the long-term. This suggests that weekend support across healthcare networks is in need of rapid improvement.”
Dr Potluri added, “Our research also reveals that the weekend effect is not a universal phenomenon. Across the two conditions we studied, its impact was varied, suggesting it can’t be tackled effectively by blanket improvements to care.
“Further research is urgently needed to assess what the implications of the weekend effect are for individual conditions before any costly changes to services are implemented.”
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1. Normally, the heart’s natural pacemaker sends out a regular electrical impulse that travels through the heart. But when someone has atrial fibrillation (AF), impulses fire off from different places in the atria causing chaotic electrical activity, which makes them have an irregular, and sometimes fast, pulse. AF affects about one million people in the UK – or 1.7 per cent of the population – but many more are undiagnosed and are unaware that they have it.
2. Across the UK there are more than 500,000 people diagnosed with heart failure and 75,000 people under the age of 65. Heart failure is a disabling condition and severe heart failure can have a worse life expectancy than many cancers. It is most commonly caused following a heart attack when the heart muscle suffers irreparable damage and can no longer pump blood efficiently around the body. In severe cases people with heart failure are left unable to perform regular day to day activities like walking upstairs or are left breathless, even when resting. Up to a third of patients admitted to hospital with heart failure will die within twelve months (NICOR National Heart Failure Audit 2013/14 http://www.ucl.ac.uk/nicor/audits/heartfailure/documents/annualreports/hfannual13-14.pdf)
Research involved the records of 929,552 patients (42,687 admitted with atrial fibrillation (AF) and 31,760 discharged following heart failure) between 1 January 2000 and 31 March 2013 across a number of North England hospitals. Data was analysed according to the ACALM (Algorithm for Comorbidities, Associations, Length of stay and Mortality) study protocol.
About Dr Rahul Potluri
Dr Rahul Potluri is a Clinical lecturer at Aston University Medical School and founder of the ACALM (Algorithm for Comorbidites, Associations, Length of Stay and Mortality) Study Unit.
About Aston University
Founded in 1895 and a University since 1966, Aston University has been always been a force for change. For 50 years the University has been transforming lives through pioneering research, innovative teaching and graduate employability success. Aston is renowned for its opportunity enabler through broad access and inspiring academics, providing education that is applied and has real impact on all areas of society, business and industry. True to Aston’s Coat of Arms which bears the word ‘Forward’, in 2016 Aston will hold a year-long anniversary celebration to recognise its heritage and achievements, but with a focus to drive forward the next stage in the University’s exciting journey. www.aston.ac.uk/50