Monday best time for hospitalisation with heart failure

Patients hospitalised for heart failure have better odds of survival if admitted on Mondays or in the morning, while mortality and length of stay are highest in those admitted in January and on Friday, new study claims.
The analysis of nearly one million heart failure admissions over 14 years was presented by Dr David P Kao at the Heart Failure Congress 2013 in Lisbon, Portugal.
The study examined the impact of day, month and hour of admission on in-hospital mortality and length of stay in 949,907 hospitalisations for congestive heart failure. Data was analysed from all hospitals in New York from 1994 to 2007.

"These findings confirm the huge decline in mortality in hospitals for heart failure over the past 14-15 years following major advances in therapy," Kao said.
Daily heart failure admissions peaked in February, while in-hospital mortality and length of stay peaked in January.
Mortality and length of stay were lowest for admissions in the morning (06h00-12h00) and highest overnight (18h00-24h00) by a small margin. Mortality and length of stay were lowest in patients admitted on Monday and highest on Friday.

"For the first time we've shown that there wasn't a higher rate of alcohol and drug use reported in heart failure patients during December and January, when heart failure mortality was the highest," Kao said.

Seasonal variations affected rate of heart failure hospitalisation and mortality in patients over the age of 30, and the effect was greater with advancing age.
An increase in concurrent pneumonia in the winter could impact on heart failure mortality, but there was less seasonal variation in other respiratory diseases like chronic obstructive pulmonary disease (COPD).
The findings suggest that staffing may have an impact on seasonal variations in mortality and length of stay.
"The fact that patients admitted right before the weekend and in the middle of the night do worse and are in hospital longer suggests that staffing levels may contribute to the findings, Kao said.

"The seasonal effect on in-hospital death from heart failure remained even after controlling for time and weekday of admission, 17 other medical conditions including substance use, kidney disease, and pneumonia, and demographic factors including gender, ethnicity, and medical coverage status.
"Seasonal variations in morbidity and mortality occur in many diseases, particularly heart disease, and the cold weather itself may have a part to play," Kao said.