What's The Best Time NOT To Have A Heart Attack?

On the weekend.

Researchers pouring over an enormous amount of data have concluded that 10 out of 1,000 patients suffering a heart attack die because they were admitted to a hospital on a weekend. Writing in the New England Journal of Medicine, they conclude that the "weekend effect" could account for several thousand deaths per year in the United States.

One likely cause is that percutaneous coronary intervention (PCI) is performed only half as much on the weekend as during the week. PCI -- aka balloon angioplasty -- improves survival 15% - 30% versus thrombolysis (using drugs to break down clots). But it's an invasive procedure that requires specialized staff in the cath lab ... and they may not be there on Saturday or Sunday.

It's not just the cath lab. There are fewer staff in general on the weekend, and generally less senior physicians and nurses.

The study looked at over 200,000 hospital admissions for first myocardial infarction ("heart attack") in New Jersey over a sixteen year period. The researchers adjusted their data to eliminate the effects of possible weekend variation from demographic characteristics, other health problems, complications, and type of heart attack.

An earlier study of ICU patients only found the risk of death for weekend admissions was 9% higher than midweek (Tuesday - Thursday) admissions, although higher mortality rates for Monday and Friday admissions to back off blaming the "weekend effect" entirely.

A 2001 study found that weekend admissions were linked to "significantly higher mortality rates for 23 of the 100 leading causes of death," and no case where weekend admission was a benefit.

In an accompanying editorial, two doctors from Ontario -- where there are weekend bonuses for medical staff -- make these recommendations for patients:

• if you feel sick during the week, don't wait until the weekend to see if you'll feel better;
• if you're not sure how sick you are, contact your doctor by Friday;
• studies aside, don't wait until Monday. Being at the hospital, even on a weekend, is much safer than being at home.

Coronary artery disease is the leading cause of death in the United States. 40% of the 1.1 million annual heart attacks are fatal.