J Card Fail. 2023 May 25:S1071-9164(23)00188-4. doi: 10.1016/j.cardfail.2023.05.010. Online ahead of print.
BACKGROUND: Whether timing of hospital presentation impacts care delivery and clinical outcomes for patients hospitalized for heart failure (HF) remains a matter of debate. In this study, we examined all-cause and HF-specific 30-day readmission rates for patients who were admitted for HF on a weekend versus admitted for HF on a weekday.
METHODS: We conducted a retrospective analysis using the 2010 - 2019 Nationwide Readmission Database to compare 30-day readmission rates among patients who were admitted for HF on a weekday (Monday-Friday) versus patients who were admitted for HF on a weekend (Saturday-Sunday). We also compared in-hospital cardiac procedures and temporal trends in 30-day readmission by day of index hospital admission.
RESULTS: Among 8,270,717 index HF hospitalizations, 6,302,775 were admitted on weekday and 1,967,942 admitted on a weekend. For weekday and weekend admissions, the 30-day all-cause readmission rates were 19.8% versus 20.3%, and HF-specific readmission rates were 8.1% versus 8.4%, respectively. Weekend admissions were independently associated with higher risk of all-cause (aOR 1.04, 95% CI 1.03 - 1.05, p<0.001) and HF-specific readmission (aOR 1.04, 95% CI 1.03 - 1.05, p<0.001). Weekend HF admissions were less likely to undergo echocardiography (aOR 0.95, 95% CI 0.94 - 0.96, p<0.001), right heart catheterization (aOR 0.80, 95% CI 0.79 - 0.81, p<0.001), electrical cardioversion (aOR 0.90, 95% CI 0.88 - 0.93, p<0.001) and temporary mechanical support devices (aOR 0.84, 95% CI 0.79 - 0.89, p<0.001). Mean length of stay was shorter for weekend HF admissions (5.1 versus 5.4 days, p<0.001). Between 2010 and 2019, 30-day all-cause (18.5% to 18.2%, trend p<0.001) and HF-specific (8.4% to 8.3%, trend p <0.001) readmission rates decreased among weekday HF admissions. Among weekend HF admissions, the HF-specific 30-day readmission rate decreased (8.8% to 8.7%, trend p<0.001), but all-cause 30-day readmission rate remained stable (trend p=0.280).
CONCLUSIONS: Among patients hospitalized for HF, weekend admissions were independently associated with excess risk of 30-day all-cause and HF-specific readmission and lower likelihood of undergoing in-hospital cardiovascular testing and procedures. The 30-day all-cause readmission rate has decreased modestly over time among patients admitted on weekdays, but has remained stable among patients admitted on weekends.