Undergraduate Student St. Paul's Hospital Vancouver, British Columbia, Canada
Background: While long-term management of acute heart failure (AHF) typically begins at hospital discharge – with initiation of guideline-directed medical therapy (GDMT), provision of education, and specialist referrals – variability in hospital operations across different days of the week may influence discharge quality. In this study, we explore whether discharge timing is associated with differences in the treatment and disposition of patients with AHF.
METHODS AND RESULTS: We analysed data from the Canadian Heart Failure (CAN-HF) registry, a national database of individuals hospitalized for AHF. Patients were categorized by discharge timing (weekday vs. weekend), and clinical characteristics, treatment patterns, and discharge dispositions were compared between groups.
Of 842 AHF patients with documented discharge dates, 713 (84.7%) were discharged on a weekday, while 129 (15.3%) were discharged on the weekend. There were no significant differences in baseline demographics (age: 75.6 ± 14.3 vs. 74.6 ± 14.0 years, p=0.45; male: 56.3% vs. 56.8%, p=0.91), comorbidities, or pre-admit medications between those discharged on weekdays versus weekends. Patients discharged on weekdays had comparable N-terminal pro BNP (NT-proBNP) (6183 pg/mL, interquartile range (IQR) [2629-11548] vs. 4151 pg/mL, IQR [3309-7012]; p=0.65), serum creatinine (112.0 µmol/L, IQR [86.0-155.0] vs. 115.0 µmol/L, IQR [93.0-154.0]; p=0.68), and potassium levels (4.0 mmol/L, IQR [3.7-4.4] vs. 4.0 mmol/L, IQR [3.6-4.3]; p=0.13) at discharge. More patients discharged on weekdays compared to weekends had discharge BNP/NT-proBNP measurements (12.9% vs. 6.1%, p=0.025), but there was no difference in heart failure (HF)-directed education (32.8% vs. 38.6%, p=0.19), discharge referrals to cardiologists and heart function clinics (33.8% vs. 36.4%, p=0.57; 30.1% vs. 30.3%, p=0.97), or the timing to heart function clinic appointments from discharge (14 days IQR [11-26] vs. 17 days IQR [12-25], p=0.65). For patients with HF with reduced ejection fraction (HFrEF), there was no change in the likelihood of angiotensin-converting enzyme inhibitor (ACEi), angiotensin receptor blocker (ARB), mineralocorticoid receptor antagonist (MRA), or beta-blocker prescription at discharge in both unadjusted and adjusted analysis (Table 1). There were no differences in GDMT prescription between teaching and non-teaching hospitals on weekdays versus weekends (p-values for interaction: ACEi = 0.57, ARB = 0.51, MRA = 0.22, beta-blocker = 0.44).
Conclusion: These results suggest that discharge timing does not impact treatment at discharge or disposition of patients with AHF. Patients received comparable education, referrals, and medications, indicating consistent hospital practices throughout the week. These findings challenge concerns about lower quality care from weekend discharges of patients with AHF.
