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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.
MedLine Citation:
PMID:  22705606     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVES: 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.
DESIGN AND SETTING: Prospective observational study of ACS patients enrolled in the Saudi Project for Assessment of Acute Coronary Syndrome study from December 2005 to December 2007.
PATIENTS AND 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.
Authors:
Hussam F Al; Lukman Thalib; Khalid F Alhabib; Anhar Ullah; Khalid Alnemer; Shukri M Alsaif; Amir N Taraben; Asif Malik; Ahmed M Abuosa; Layth A Mimish; Ahmad Salah Hersia
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of Saudi medicine     Volume:  32     ISSN:  0975-4466     ISO Abbreviation:  Ann Saudi Med     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-06-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8507355     Medline TA:  Ann Saudi Med     Country:  India    
Other Details:
Languages:  eng     Pagination:  366-71     Citation Subset:  IM    
Affiliation:
Dr. Hussam F. AlFaleh MBBS FRCP, Assistant Professor of Medicine, College of Medicine, King Saud University, PO Box 7805, Riyadh 11472, Saudi Arabia T: +9661 467-1161/1829 F:+9661 467-1588 halfaleh@ksu.edu.sa.
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