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Weekend Effect for Pulmonary Embolism and Other Acute Cardiovascular DiseasesWeekend Effect For Cardiovascular Diseases FREE TO VIEW

Roberto Manfredini, MD; Raffaella Salmi, MD; Massimo Gallerani, MD
Author and Funding Information

From the Department of Medical Sciences and Vascular Diseases Center (Dr Manfredini), University of Ferrara; and the 2nd Internal Medicine Unit (Dr Salmi), and 1st Internal Medicine Unit (Dr Gallerani), Azienda Ospedaliera-Universitaria of Ferrara.

Correspondence to: Roberto Manfredini, MD, Clinica Medica, Department of Medical Sciences and Vascular Diseases Center, Via Savonarola 9, 44124 Ferrara, Italy; e-mail: roberto.manfredini@unife.it


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(1):275-276. doi:10.1378/chest.12-2060
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To the Editor:

In an issue of CHEST (September 2012), Nanchal et al1 presented interesting data about the existence of a “weekend effect” for pulmonary embolism. Patients admitted to the hospital on a weekend, in fact, had a 19% increased risk of death. These results represent further confirmation of previous reports from Canada (cited by the authors) and from the Emilia-Romagna region of Italy by our group2 that both found a 17% increased risk of death.

We have extensively explored the possible presence of a different mortality rate between weekdays and weekends and confirmed an even greater increased risk of death for other acute cardiovascular diseases as well (ie, acute heart failure [OR, 1.33]3 and aortic aneurysm rupture or dissection [OR, 1.31]3). Medical and nursing understaffing, shortage of diagnostic or procedural services, and presence of inexperienced residents have been suggested as possible causes. However, the data collected in Italy (and in the Emilia-Romagna region in particular) do not support such interpretations, since that health system and the hospital service organization in Italy are not comparable with that of countries like the United States or the United Kingdom.4

Temporal aspects of onset of acute cardiovascular and cerebrovascular diseases might play a role as well, and patterns of circadian and seasonal times of onset of certain diseases are known. It is possible that acute diseases do not present with equal severity relative to time, that is, day of the week or hour of the day. A single-center study on acute coronary syndromes (ACSs) explored this possibility and showed that, although there were fewer ACS admissions than expected on nights and weekends, the proportion of patients with ACS presenting with ST-elevation myocardial infarctions was 64% higher on weekends.5 A higher severity might be linked with higher risk of mortality, and several parameters of severity collected by Nanchal et al1 (eg, need for mechanical ventilation, thrombolytic therapy use, or use of vasopressors) are in agreement with this. Further studies are needed to explore this intriguing relationship between time of presentation and clinical outcome of acute cardiovascular diseases.

References

Nanchal R, Kumar G, Taneja G, et al; from the Milwaukee Initiative in Critical Care Outcomes Research (MICCOR) Group of Investigators. Pulmonary embolism: the weekend effect. Chest. 2012;142(3):690-696. [CrossRef] [PubMed]
 
Gallerani M, Imberti D, Ageno W, Dentali F, Manfredini R. Higher mortality rate in patients hospitalised for acute pulmonary embolism during weekends. Thromb Haemost. 2011;106(1):83-89. [CrossRef] [PubMed]
 
Gallerani M, Boari B, Manfredini F, Mari E, Maraldi C, Manfredini R. Weekend versus weekday hospital admissions for acute heart failure. Int J Cardiol. 2011;146(3):444-447. [CrossRef] [PubMed]
 
Gallerani M, Imberti D, Bossone E, Eagle KA, Manfredini R. Higher mortality in patients hospitalized for acute aortic rupture or dissection during weekends. J Vasc Surg. 2012;55(5):1247-1254. [CrossRef] [PubMed]
 
LaBounty T, Eagle KA, Manfredini R, et al. The impact of time and day on the presentation of acute coronary syndromes. Clin Cardiol. 2006;29(12):542-546. [CrossRef] [PubMed]
 

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References

Nanchal R, Kumar G, Taneja G, et al; from the Milwaukee Initiative in Critical Care Outcomes Research (MICCOR) Group of Investigators. Pulmonary embolism: the weekend effect. Chest. 2012;142(3):690-696. [CrossRef] [PubMed]
 
Gallerani M, Imberti D, Ageno W, Dentali F, Manfredini R. Higher mortality rate in patients hospitalised for acute pulmonary embolism during weekends. Thromb Haemost. 2011;106(1):83-89. [CrossRef] [PubMed]
 
Gallerani M, Boari B, Manfredini F, Mari E, Maraldi C, Manfredini R. Weekend versus weekday hospital admissions for acute heart failure. Int J Cardiol. 2011;146(3):444-447. [CrossRef] [PubMed]
 
Gallerani M, Imberti D, Bossone E, Eagle KA, Manfredini R. Higher mortality in patients hospitalized for acute aortic rupture or dissection during weekends. J Vasc Surg. 2012;55(5):1247-1254. [CrossRef] [PubMed]
 
LaBounty T, Eagle KA, Manfredini R, et al. The impact of time and day on the presentation of acute coronary syndromes. Clin Cardiol. 2006;29(12):542-546. [CrossRef] [PubMed]
 
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