Incidence, admission and case-fatality of acute myocardial infarction: Weekend versus weekday in a Japanese population: 16-year results from Takashima AMI Registry (1988-2003)
Department of Health Science, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan. European Journal of Epidemiology
(Impact Factor: 5.34).
02/2009; 24(2):93-100. DOI: 10.1007/s10654-008-9308-5
For acute myocardial infarction (AMI), “weekend” has been associated with higher incidence, admission, and fatality. But, very few studies in this regard are available in Japan. Day of the week variation in AMI was examined using an entire community covering 16-year AMI registration data from Japan. Data were obtained from the Takashima AMI Registry, which covers a stable population of approximately 55,000 in central Japan. There were 379 registered first ever AMI cases with 121 fatal events within 28 days of onset during 1988–2003. We divided the days into two groups: ‘Weekend’ (Saturday and Sunday) and ‘Weekdays’ (Monday to Friday). The incidence rate (per 100,000 person-year), admission rate (per 1,000 days) and 28-day case-fatality rates (per 100 events) as well as corresponding rate ratios were calculated with 95% confidence intervals. The distribution of the day of the week for onset, admission and fatality for all subjects was fairly random in our study population; incidence (χ
2 test, P = 0.8), admission (χ
2 test, P = 0.9) and case-fatality (χ
2 test, P = 0.8). The incidence, admission, and case-fatality rates were similar for the 2 day-groups. The incidence rate ratio 1.06 (95% CI: 0.9–1.3), admission ratio 1.03 (95% CI: 0.8–1.3), and case-fatality ratio 1.18 (95% CI: 0.7–1.9) showed no significant risk difference between weekend and weekday. After various adjustments, hazard ratio for weekend AMI in reference to weekday AMI was 1.07 (95% CI: 0.5–2.1). There were no obvious differences in occurrence, hospital admission and acute outcome for AMI patients in the weekday or weekend.
Available from: Jassim Al Suwaidi
- "A large study of patients with acute MI, from United States (n = 62,814), also could not show higher in-hospital mortality in weekend and off-hours admissions compared with those presenting during weekdays and regular hours  Another study from Switzerland (n = 12,480), after adjusting for several confounding variables, could not demonstrate the “weekend effect” in patients with acute MI, and reported equal survival rates (P = 1.00) for weekday and weekend groups . In a large Japanese registry study, there were no obvious differences in occurrence, hospital admission and acute outcome for acute MI patients in the weekday or weekend . In a study from Italy, there was an increased incidence of ST-elevation MI during weekends and night hours, which was not seen in the current study . "
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ABSTRACT: We used prospective cohort data of patients with acute coronary syndrome (ACS) to compare their manage-ment on weekdays/mornings with weekends/nights, and the possible impact of this on 1-month and 1-year mortality. Analyses were evaluated using univariate and multivariate statistics. Of the 4,616 patients admitted to hospitals with ACS, 76% were on weekdays. There were no significant differences in 1-month (odds ratio (OR), 0.88; 95% CI: 0.68-1.14) and 1-year mortality (OR, 0.88; 95% CI: 0.70-1.10), respectively, between weekday and weekend admissions. Similarly, there were no significant differences in 1-month (OR, 0.92; 95% CI: 0.73-1.15) and 1-year mortality (OR, 0.98; 95% CI: 0.80-1.20), respectively, between nights and day admissions. In conclusion, apart from lower utilization of angiography (P < .001) at weekends, there were largely no significant discrepancies in the management and care of patients admitted with ACS on weekdays and during morning hours compared with patients admitted on weekends and night hours, and the overall 30-day and 1-year mortality was similar between both the cohorts.
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ABSTRACT: This paper investigates the decentralized variable structure control problem of three-area interconnected power systems with parameter perturbation, interconnection and exterior disturbance. This approach realizes the decentralized control based on the variable structure control theory, at the same time the global asymptotic stability of the whole systems has been proved. This approach has good robustness and is not sensitive to parameter perturbation. Simulation results show that this method is effective.
Available from: Susan Yap
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ABSTRACT: Marcus EH Ong1, Faith SP Ng2, Susan Yap1, Kok Leong Yong1, Mary A Peberdy3, Joseph P Ornato41Department of Emergency Medicine, Singapore General Hospital, Singapore; 2Clinical Trials and Epidemiology Research Unit (now known as Singapore Clinical Research Institute), Singapore; 3Division of Cardiology, Virginia Commonwealth University – Medical College of Virginia, Richmond, VA, USA; 4Department of Emergency Medicine, Virginia Commonwealth University – Medical College of Virginia, Richmond, VA, USAObjective: We aimed to determine whether there is a seasonal variation of out-of-hospital cardiac arrests (OHCA) in an equatorial climate, which does not experience seasonal environmental change.Methods: We conducted an observational prospective study looking at the occurrence of OHCA in Singapore. Included were all patients with OHCA presented to Emergency Departments across the country. We examined the monthly, daily, and hourly number of cases over a threeyear period. Data was analyzed using analysis of variance (ANOVA).Results: From October, 1st 2001 to October, 14th 2004, 2428 patients were enrolled in the study. Mean age for cardiac arrests was 60.6 years with 68.0% male. Ethnic distribution was 69.5% Chinese, 15.0% Malay, 11.0% Indian, and 4.4% Others. There was no significant seasonal variation (spring/summer/fall/winter) of events (ANOVA P = 0.71), monthly variation (P = 0.88) or yearly variation (P = 0.26). We did find weekly peaks on Mondays and a circadian pattern with daily peaks from 9–10 am.Conclusions: We did not find any discernable seasonal pattern of cardiac arrests. This contrasts with findings from temperate countries and suggests a climatic influence on cardiac arrest occurrence. We also found that sudden cardiac arrests follow a circadian pattern.Keywords: cardiopulmonary resuscitation, cardiac arrest, seasonal pattern, circadian pattern
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