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(HealthNewsDigest.com) – DALLAS, Aug. 25, 2011 — Stroke patients admitted on the weekend have higher death rates than those admitted on weekdays at many hospitals, but not at state-certified Comprehensive Stroke Centers, according to a report in Stroke: Journal of the American Heart Association.
Patients admitted to New Jersey hospitals on the weekend were 5 percent
more likely to die within 90 days than patients hospitalized during the
week, the report shows. There was no difference in the 90-day death
rate at the comprehensive stroke centers, regardless of when patients
were admitted.
“The ‘weekend effect’ suggests patients admitted or treated during
weekend hours will receive different care, have worse outcomes, which
could account for several thousand U.S. deaths,” said James McKinney,
M.D., lead researcher and assistant professor of neurology at the
University of Medicine and Dentistry New Jersey-Robert Wood Johnson
Medical School in New Brunswick.
“Prior studies of the weekend effect have looked at in-hospital death
rates and death rates right after discharge, but we wanted to look at
longer outcomes after admission,” McKinney said. “We also wanted to
determine if New Jersey’s unique stroke center designations impacted
patient treatment and outcomes.”
In 2004, New Jersey enacted the Stroke Centers Act to allow hospitals
to apply for designation as Comprehensive Stroke Centers or Primary
Stroke Centers, determined by their level of specialized care.
Hospitals with Comprehensive or Primary Stroke Center designation are
equipped to evaluate, stabilize and provide emergency care to patients
with acute stroke symptoms, but only Comprehensive Stroke Centers are
prepared to offer specialized care for complex strokes.
Researchers examined records of 134,441 stroke patients discharged from
88 private acute care hospitals in New Jersey between 1997 and 2007.
Among them, 23.4 percent were admitted to one of 12 Comprehensive
Stroke Centers, 51.5 percent to one of 43 Primary Stroke Centers and
25.1 percent to one of 33 non-stroke centers. The researchers
determined out-of-hospital mortality rates up to one year after
admission.
Patients admitted on the weekend had a significantly higher death rate
(17.2 percent) within 90 days compared to patients admitted on a
weekday (16.5 percent). After adjusting for patient demographics and
coexisting conditions, the weekend effect had a 5 percent difference in
overall death rates, making it both significant and clinically
meaningful, McKinney said.
Researchers also found:
— 28 percent of all stroke patients were admitted on the weekend.
— On the weekend, patients were more likely to be admitted to
Comprehensive Stroke Centers.
— Patients admitted to Comprehensive or Primary Stroke Centers on the
weekend had 5 percent lower 90-day mortality rates compared to those
admitted to a non-stroke center.
— Patients admitted after 2006 were 10 times more likely to receive IV
thrombolysis, which is a treatment used to break up a blood clot that
commonly causes most strokes.
— Despite the improvement in using thrombolysis, a “weekend effect” was
present for stroke patients admitted to Primary Stroke Centers or
non-stroke centers.
“The reduction in 90-day mortality from 1996-1997 to 2006-2007 (after
the stroke center designations) could indicate that the statewide
designation process had a positive effect on stroke care as a whole
across New Jersey and deserves further study,” McKinney said.
More advanced comprehensive stroke care could not only reduce the
weekend effect, but could improve overall patient care and save lives,
researchers said.
“Our experience tells us that specialized stroke expertise, methods for
monitoring performance and formal care protocols at Primary Stroke
Centers and Comprehensive Stroke Centers helps explain why these
centers are associated with improved stroke care and clinical
outcomes,” said Gregg Fonarow, M.D., chairman of American Heart
Association Hospital Accreditation Science Committee and professor of
cardiovascular medicine of the University of California, Los Angeles.
“The American Heart Association/American Stroke Association strongly
supports implementing stroke systems of care as well as hospital
accreditation of Primary Stroke Centers/Comprehensive Stroke Centers,”
Fonarow said.
Co-authors are: Yingzi Deng, M.D., M.S.; Scott E. Kasner, M.D.,
M.S.C.E.; and John B. Kostis, M.D. Author disclosures are on the
manuscript.
The Robert Wood Johnson Foundation and the Schering-Plough Foundation
funded the study.
The American Heart Association logo is available at
http://www.globenewswire.com/newsroom/prs/?pkgid=9940
Statements and conclusions of study authors published in American Heart
Association scientific journals are solely those of the study authors
and do not necessarily reflect the association’s policy or position.
The association makes no representation or guarantee as to their
accuracy or reliability. The association receives funding primarily
from individuals; foundations and corporations (including
pharmaceutical, device manufacturers and other companies) also make
donations and fund specific association programs and events. The
association has strict policies to prevent these relationships from
influencing the science content. Revenues from pharmaceutical and
device corporations are available at www.heart.org/corporatefunding.
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