Impact of On-Hours Versus Off-Hours Presentation on Mortality in ST-Segment Elevation Myocardial Infarction Patients

Sidra Qayyum Malik; Fatima Qayyum; Imran Khan; Sobia Ali; Syed Imran Kazmi

doi:10.51253/pafmj.v75i6.9969

Authors

Sidra Qayyum Malik Department of Cardiology, Benazir Bhutto Shaheed Teaching Hospital, Abbottabad Pakistan
Fatima Qayyum Department of Medicine, Ayub Medical Teaching Institute, Abbottabad Pakistan
Imran Khan Department of Cardiology, Ayub Medical Teaching Institute, Abbottabad Pakistan
Sobia Ali Department of Community Medicine, Ayub Medical College, Abbottabad Pakistan
Syed Imran Kazmi Department of Cardiology, Benazir Bhutto Shaheed Teaching Hospital, Abbottabad Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75i6.9969

Keywords:

Mortality, Off Hours, On Hours, St-Elevation Myocardial Infarction

Abstract

Objective: To compare in-hospital mortality rates of ST-Segment Elevation Myocardial Infarction (STEMI) patients based on their admission times, either during on or off hours.

Study Design: Prospective Longitudinal Study.

Place and Duration of Study: Cardiology Department, Ayub Teaching Hospital, Abbottabad Pakistan, from Aug to Dec 2019.

Methodology: This study recruited STEMI patients from a tertiary care hospital. A validated questionnaire was used to collect patient data regarding demographic profiles. Data was collected by consecutive non-probability sampling.

Results: A total of 266 patients were included; 74 were admitted during regular hours, while 192 were admitted during off-hours. There was no significant difference in thrombolysis time between regular and off-hours. In-hospital mortality occurred in 14(18.9%) patients admitted during regular hours and 19(9.9%) patients admitted during off-hours, indicating higher mortality during regular hours (p-value =0.040). The door-to-thrombolysis time during either period was not linked to increased mortality. Systolic blood pressure at admission was a significant variable associated with higher mortality (p-value =0.001). This suggests that patient disease severity at the time of admission may explain the difference in mortality, rather than the admission time itself.

Conclusion: Mortality difference exists among STEMI patients during on hours and off hours, which is attributed to the severity of disease at admission, and not to the difference in provision of medical care at off time or staff availability. These results suggest that an aggressive treatment protocol should be administered to STEMI patients with hemodynamic compromise.

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