Prognostic impact of the presence of on-duty cardiologist on patients with acute myocardial infarction admitted during off-hours.

Abstract

BACKGROUND:

Owing to reduced staffing, patients hospitalized for acute myocardial infarction (AMI) during off-hours (nights, weekends, and holidays) have poorer outcomes than those admitted during regular hours. Whether the presence of an on-duty cardiologist in a hospital during off-hours is related to better outcomes for patients with AMI remains unclear. The Miyazaki Prefectural Nobeoka Hospital had a unique medical care system in that cardiologists were on call for half of the week and on duty for the other half during off-hours, thus providing an opportunity to assess the relationship between the presence of an on-duty cardiologist and patient outcomes. We examined clinical outcomes of patients admitted for AMI during off-hours according to the presence of an on-duty cardiologist.

METHODS:

We recruited 225 consecutive patients with AMI hospitalized during off-hours, who underwent stent implantation at Miyazaki Prefecture Nobeoka Hospital from 2013 to 2017. The endpoints were in-hospital death or long-term major adverse cardiac events (MACE) including cardiovascular death, non-fatal MI, non-fatal stroke, stent thrombosis, ischemia-driven target-lesion revascularization, admission owing to unstable angina, or admission owing to heart failure.

RESULTS:

Based on the presence of an on-call cardiologist at admission, we divided patients into the cardiologist on-call group (n = 112) or cardiologist on-duty group (n = 113). The presence of an on-duty cardiologist did not affect door-to-reperfusion time (p = 0.776), level of peak creatine kinase (p = 0.971), or in-hospital death (p = 0.776). The Kaplan-Meier curve analysis showed similar prognosis for the cardiologist on-duty and cardiologist on-call groups (p = 0.843), and multivariable Cox regression analysis showed that the presence of an on-duty cardiologist was not associated with MACE.

CONCLUSIONS:

The presence of an on-duty cardiologist is not a prognostic factor for patients hospitalized for AMI during off-hours in our medical system. Further prospective multicenter studies should confirm our results.

• Authors: Kyohei Marume, Katsuki Nagatomo, Nobuyasu Yamamoto, Ryota Kaichi, Takayuki Mori, Soichi Komaki, Masanobu Ishii, Hiroaki Kusaka, Reiko Toida, Kazumasa Kurogi, Yasuhiro Nagamine, Seiji Takashio, Yuichiro Arima, Kenji Sakamoto, Eiichiro Yamamoto, Koichi Kaikita, Kenichi Tsujita
• Journal: Journal of cardiology (J Cardiol) Vol. 76 Issue 2 Pg. 184-190 (08 2020) ISSN: 1876-4738 [Electronic] Netherlands
• PMID: 32199752 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Cardiologists
• Female
• Hospitalization (statistics & numerical data)
• Hospitals
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Myocardial Infarction (mortality, therapy)
• Personnel Staffing and Scheduling
• Prognosis
• Treatment Outcome