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Day vs night shift differences in acute coronary syndrome outcomes
Session:
Painel 8 - Doença Coronária 9
Speaker:
Nuno Craveiro
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Nuno Craveiro; Kevin Domingues; Bruno Miranda Castilho; Ana Rita Moura; Mariana Saraiva; Marisa Peres; Vitor Paulo Martins
Abstract
<p><strong>Introduction</strong> Outcomes in acute coronary syndrome (ACS) depend on prompt diagnosis and interventions aiming early and effective revascularization of a nearly or totally occluded coronary artery. Unsuccessful or late revascularization is associated with arrhythmic, heart failure (HF) and mechanical complications. Emergency department (ED) organization between day and night shifts may influence the quality of care of ACS patients.</p> <p><strong>Objective </strong>To analyse outcome differences between day and night shift presentation in an ACS population from a district hospital</p> <p><strong>Methods </strong>We analised a district hospital database of ACS patients, admitted from 2011 to 2018, divided in two groups: Group 1 – patients presenting to the ED from 9 am to 9 pm (day shift) and Group 2 – patients presenting to the ED from 9 pm to 9 am (night shift). Arrival-to-ECG times, demographic, analytic, therapeutic and outcome data were analysed.</p> <p><strong>Results </strong>There was a total of 1333 patients included in this study. 818 patients (61%) presented to the ED during the day shift and 515 (39%) during the night shift. There were no significant differences between group characteristics apart from age (70±13 years vs 68±13 years; p=0.002). Arrival-to-ECG time was statistically different between the 2 groups (p=0.043). There were no significant differences in the percentage of patients who underwent coronary angiography (CAG), number of occluded arteries at CAG or rates of revascularization (either by PCI or planned CABG) between groups as well as no differences in troponin elevation or BNP values. Reduced left ventricle ejection fraction (LVEF<40%) measured by transthoracic echocardiography was significantly lower in Group II (24.3% vs 19.2% p=0.045), which also had higher rates of in-hospital worsening of heart failure (8.2% vs 2.7% p<0.001) and urgent hospitalization at 1-year follow-up (20.5% vs 14.3% p=0.034). There were no significant differences of in-hospital or one-year mortality between groups. In multivariate analysis, presentation to the ED during the night shift was an independent predictor of LVEF<40% (OR 1.38, CI 1.01-1.88, p=0.045) and in-hospital worsening of HF (OR 3.03 CI 1.69-5.43, p<0.001).</p> <p><strong>Conclusion </strong>Patient presentation to the ED during the night shift (9 pm to 9 am) is associated with lower LVEF at discharge as well as worse heart-failure related outcomes. Measures must be taken to lessen the day-night shift differences in ACS patients care delivery.</p>
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