入院日对完全性心脏传导阻滞患者的影响：分析周末效应。

Impact of day of admission on patients admitted with complete heart block: Analyzing the weekend effect.

机构信息

Department of Internal Medicine, The University of Toledo Medical Center, Toledo, OH, USA.

Department of Cardiology, Tufts Medical Center, Boston, Massachusetts, USA.

出版信息

Heart Lung. 2025 Jan-Feb;69:168-173. doi: 10.1016/j.hrtlng.2024.10.007. Epub 2024 Oct 30.

DOI:10.1016/j.hrtlng.2024.10.007

PMID:39471644

Abstract

BACKGROUND

Complete heart block (CHB) is a conduction disorder that can be fatal if not treated promptly. Admission on a week or weekend day may influence the outcomes of cardiac emergencies, such as CHB.

OBJECTIVES

The purpose of this study was to determine the effects of weekday vs. weekend admissions in terms of CHB outcomes.

METHODS

A retrospective cohort study was conducted using the National Inpatient Sample database to study the outcomes of adult patients admitted with complete heart block. Outcomes were compared between the patients admitted on weekends (midnight Friday to midnight Sunday) and weekdays.

RESULTS

Thirty-four thousand three hundred ninety-five patients were included, of which 7350 (21.37 %) were admitted on weekends. Mean age for included patients was 75.69 years, with 43.23 % females. Compared to those admitted on weekdays, participants admitted on weekends had similar mortality (aOR 0.73; 95 % CI 0.46-1.16), longer length of stay (mean increase 0.74 days; P < 0.01) and higher hospital charges (mean increase $10,540.82; P < 0.01). Weekend admissions were associated with higher rates of cardiac arrest (adjusted OR 1.40; 95 % CI 1.07-1.84; P = 0.02) and higher rates of cardiogenic shock (adjusted OR 1.40; 95 % CI 1.07-1.83; P = 0.01) and similar rates of permanent pacemaker implantation (adjusted OR 0.88; 95 % CI 0.77-1.01; P = 0.06), but had longer delay to permanent pacemaker (mean increase 0.46 days; P < 0.01).

CONCLUSION

Hospital and administrative-level strategies are needed to address the differences between the weekend and weekday CHB admissions.

摘要

背景

完全性心脏阻滞（CHB）是一种传导障碍，如果不及时治疗可能是致命的。在一周或周末入院可能会影响心脏急症的结果，如 CHB。

目的

本研究旨在确定工作日与周末入院在 CHB 结果方面的影响。

方法

使用国家住院患者样本数据库进行回顾性队列研究，研究完全性心脏阻滞成年患者的入院结果。将周末（周五午夜至周日午夜）和工作日入院的患者的结果进行比较。

结果

共纳入 34395 例患者，其中 7350 例（21.37%）在周末入院。纳入患者的平均年龄为 75.69 岁，女性占 43.23%。与工作日入院的患者相比，周末入院的患者死亡率相似（调整后的 OR 0.73；95%CI 0.46-1.16），住院时间更长（平均增加 0.74 天；P<0.01），住院费用更高（平均增加 10540.82 美元；P<0.01）。周末入院与心脏骤停发生率较高相关（调整后的 OR 1.40；95%CI 1.07-1.84；P=0.02），心源性休克发生率较高（调整后的 OR 1.40；95%CI 1.07-1.83；P=0.01），永久性起搏器植入率相似（调整后的 OR 0.88；95%CI 0.77-1.01；P=0.06），但永久性起搏器植入延迟更长（平均增加 0.46 天；P<0.01）。