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. 2019 Apr 14;40(15):1214-1221.
doi: 10.1093/eurheartj/ehy835.

Association between time of hospitalization with acute myocardial infarction and in-hospital mortality

Jianhua Wu  1 , Marlous Hall  2 , Tatendashe B Dondo  2 , Chris Wilkinson  2 , Peter Ludman  3 , Mark DeBelder  4 , Keith A A Fox  5 , Adam Timmis  6 , Chris P Gale  2
Affiliations

Association between time of hospitalization with acute myocardial infarction and in-hospital mortality

Jianhua Wu et al. Eur Heart J. .

Abstract

Aims: To study the association between time of hospitalization and in-hospital mortality for acute myocardial infarction (AMI).

Methods and results: Patients admitted with ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) across 243 hospitals in England and Wales between 1 January 2004 and 31 March 2013 were included. The outcome measure was in-hospital mortality. Adjusted odds ratios (ORs) for in-hospital mortality were estimated across six 4-hourly time periods over the 24-h clock using multilevel logistic regression, inverse-probability weighting propensity score, and instrumental variable analysis. Among 615 035 patients [median age 70.0 years, interquartile range 59.0-80.0 years; 406 519 (66.0%) men], there were 52 777 (8.8%) in-hospital deaths. At night, patients with NSTEMI were more frequently comorbid, and for STEMI had longer symptom-onset-to-reperfusion times. For STEMI, unadjusted in-hospital mortality was highest between 20:00 and 23:59 [4-h period range 8.4-9.9%; OR compared with 00:00-03:59 reference 1.13, 95% confidence interval (CI) 1.07-1.20], and for NSTEMI highest between 12:00 and 15:59 (8.0-8.8%; OR compared with 00:00-03:59 reference 1.07, 95% CI 1.03-1.12). However, these differences were only apparent in the earlier years of the study, and were attenuated by adjustment for demographics, comorbidities, and clinical presentation. Differences were not statistically significant after adjustment for acute clinical treatment provided.

Conclusion: There is little evidence to support an association between time of hospitalization and in-hospital mortality for AMI; variation in in-hospital mortality may be explained by case mix and the use of treatments.

Keywords: Acute myocardial infarction; In-hospital mortality; Time of hospitalization.

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Conflict of interest statement

Conflicts of interest

KAAF reports: grants and personal fees from Bayer, Janssen and AstraZeneca; personal fees from Sanofi, Regeneron and Verseon outside the submitted work. AT reports a travel grant from NovoNordisk outside the submitted work. CPG reports personal fees from AstraZeneca, Bristol Myer Squibb, Novartis and Vifor Pharma; travel grant from Bayer outside the submitted work. JW, MH, TBD, CW, PL, and MDB have nothing to disclose.

Figures

Take-home figure: Adjusted odds ratios for in-hospital mortality by time of hospitalisation, showing no significant difference across the six time-intervals of the 24-hour clock
Take-home figure: Adjusted odds ratios for in-hospital mortality by time of hospitalisation, showing no significant difference across the six time-intervals of the 24-hour clock
Figure 1
Figure 1. Crude in-hospital mortality rates by time of admission to hospital for ST-elevation myocardial infarction and non-ST-elevation myocardial infarction, stratified by biennial year of hospitalization.
Dots represent in-hospital mortality rates per every 10 min of time of admission to hospital. Time data are fitted using cubic polynomials with trigonometric transformation to the time of hospitalization to ensure that the mortaliyt at 00:05 and 23:55 is just 10 min apart. Footnote: Dots represent in-hospital mortality rates per every 10 minutes of time of admission to hospital. Time data are fitted using cubic polynomials with trigonometric transformation to the time of hospitalization to ensure that the mortality at 00.05 and 23.55 is just ten minutes apart.
Figure 2
Figure 2. Unadjusted and multivariable adjusted risk of in-hospital mortality according to time period of admission to hospital for STEMI and NSTEMI.
See this image and copyright information in PMC

Comment in

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