Resident University of Toronto Toronto, Ontario, Canada
Background: Cardiogenic shock (CS) is a life-threatening condition marked by inadequate tissue perfusion due to acute myocardial infarction or decompensated heart failure, with a high mortality rate of at least 40%. Timely multidisciplinary care, including early invasive monitoring and intervention, improves survival. However, studies suggest weekend admissions are associated with worse outcomes, including a 10% higher mortality rate, potentially due to reduced access to critical care interventions. Despite growing evidence of these disparities, no studies have examined the weekend effect on CS outcomes in Canada, particularly at quaternary centers. This study assessed the impact of weekend admissions on CS outcomes in the current era of cardiac critical care with coordinated CS teams.
METHODS AND RESULTS: A retrospective observational study used data from the CS registry at Toronto General Hospital, a regional, quaternary referral center offering advanced heart failure therapies, including durable left ventricular assist devices (LVADs) and cardiac transplant. Consecutive CS patients admitted to the Cardiac Intensive Care Unit (CICU) from January 2014 to April 2023 were included. Descriptive statistics summarized patient demographics, clinical characteristics, and outcomes. Kaplan-Meier methods compared survival between weekend and weekday admissions, with patients censored at discharge upon receiving LVAD or transplant. CICU interventions were compared between groups. Cox proportional hazards regression adjusted for potential confounders. A total of 1,616 CS admissions were analyzed: 1,214 on weekdays and 402 on weekends. Baseline demographics and clinical characteristics were similar (Table 1). There was no significant difference in in-hospital survival between weekday and weekend admissions (p = 0.931) (Figure 1). Median survival was 54 (Interquartile range, IQR 11–201) days for weekday and 64 (IQR 9–128) days for weekend admissions. Adjusted Cox regression showed no survival difference. The use of CICU interventions, including bilevel positive airway pressure, intra-aortic balloon pump, Swan Ganz catheter, renal replacement therapy, and vasopressors or inotropes, was similar across groups (Figure 2).
Conclusion: Weekend admission to a quaternary CS center was not associated with increased mortality or reduced access to CICU interventions in CS patients. These findings suggest the previously described “weekend effect” is diminishing in high-volume shock centers, likely due to streamlined transfers, specialized teams, and centralized care. This reflects progress toward consistent, high-quality care for this high-risk population, regardless of admission timing.
