Are acute coronary syndrome patients admitted during off-duty hours treated differently? An analysis of the Saudi Project for Assessment of Acute Coronary Syndrome (SPACE) study.
OBJECTIVE
It is often suggested that acute coronary syndrome (ACS) patients admitted during off-duty hours (OH) have a worse clinical outcome than those admitted during regular working hours (RH). Our objective was to compare the management and hospital outcomes of ACS patients admitted during OH with those admitted during RH.


METHODS
Prospective observational study of ACS patients enrolled in the Saudi Project for Assessment of Acute Coronary Syndrome study from December 2005 to December 2007.


METHODS
ACS patients with available date and admission times were included. RH were defined as weekdays, 8 AM-5 PM, and OH was defined as weekdays 5 PM-8 AM, weekends, during Eid (a period of several days marking the end of two major Islamic holidays), and national days.


RESULTS
Of the 2825 patients qualifying for this analysis, 1016 (36%) were admitted during RH and 1809 (64%) during OH. OH patients were more likely to present with heart failure and ST elevation myocardial infarction (STEMI) and to receive fibrinolytic therapy, but were less likely to undergo primary percutaneous coronary interventions (PCI). The median door to balloon time was significantly longer (P<.01) in OH patients (122 min) than in RH patients. No differences were observed in hospital outcomes including mortality between the two groups, except for higher heart failure rates in OH patients (11.1% vs 7.2%, P<.001).


CONCLUSIONS
STEMI patients admitted during OH were disadvantaged with respect to use and speed of delivery of primary PCI but not fibrinolytic therapy. Hospitals providing primary PCI during OH should aim to deliver it in a timely manner throughout the day.
College of Medicine, King Saud University, Riyadh, Saudi Arabia. halfaleh@ksu.edu.sa
Hussam F
HF
Al Faleh
Lukman
L
Thalib
Khalid F
KF
AlHabib
Anhar
A
Ullah
Khalid
K
AlNemer
Shukri M
SM
AlSaif
Amir N
AN
Taraben
Asif
A
Malik
Ahmed M
AM
Abuosa
Layth A
LA
Mimish
Ahmad Salah
AS
Hersia
D054058:Acute Coronary Syndrome / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D039602:After-Hours Care / Q000379:methods; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D003695:Delivery of Health Care / Q000379:methods* / Q000592:standards; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy*; D010561:Personnel Staffing and Scheduling; D011446:Prospective Studies; D012529:Saudi Arabia; D013997:Time Factors; D016896:Treatment Outcome
D005343:Fibrinolytic Agents