Weekend Hospital Admission for Heart Failure: Influence on Quality of Care, Length of Stay, and In-Hospital Mortality

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Background: Hospital admissions during weekends have been associated with worse outcomes in some but not all medical conditions. The impact of weekend vs. weekday admission for heart failure (HF) has not been well studied. The objectives of this study are to compare weekend vs. weekday HF admission for 1) quality of care (QOC), 2) length of stay (LOS), and 3) in-hospital mortality. Hypothesis: Weekend admission for HF is associated with lower QOC, longer LOS, and higher in-hospital mortality. Methods: Get with the Guidelines-HF (GWTG) employs a collaborative model of care and a web-based Management Tool™ (Outcome, Cambridge, MA). Baseline data was recorded for 59,876 HF admissions at 264 sites from 1/05 – 4/07. The cohort was stratified by weekend vs. weekday admission. Generalized Estimating Equations adjusted for patient and hospital characteristics and clustering. Results: Mean age was 73±14 yrs, LVEF 40% ± 17. In-hospital mortality was 3.3% and median LOS 5d. Patients admitted on weekends had similar comorbidities to those admitted on weekdays, but were slightly older with higher BNP levels. Weekend admission was associated with decreased odds of LVEF documentation and ICD implantation; other QOC measures were similar. There was no difference in LOS for weekend vs. weekday admission. There was a non-significant trend toward increased in-hospital mortality for weekend HF admissions.

Comparison of Weekend vs. Weekday Admissions

Conclusions: Among GWTG hospitals, weekend admission for HF was associated with similar QOC in most but not all measures. LOS was similar but risk adjusted mortality was marginally higher for weekend HF admission.