Do patients with acute coronary syndrome face higher mortality on weekends versus weekdays? A comprehensive analysis of demographic, geographic, and temporal trends in the United States

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

Background: The impact of a "weekend effect" on US acute coronary syndrome (ACS) mortality remains uncertain. We compared weekend and weekday age-adjusted mortality rates (AAMRs) and analyzed demographic, geographic, and temporal trends from 1999 to 2020.

Methods: We conducted a national analysis of ACS deaths (age ≥ 25 years) using CDC WONDER (ICD-10: I20.0; I21.0-I21.4; I21.9; I22.0-I22.9; I24.8; I24.9). Crude and AAMRs (per 100 000; 2000 U.S. standard) were calculated, and trends were assessed by joinpoint regression to estimate annual percent changes (APCs) and average APCs (AAPCs).

Results: From 1999 to 2020, there were 3, 101, 451 ACS deaths: 2, 222, 468 on weekdays (AAMR 46.4; 95% CI 46.39-46.51) and 878, 983 on weekends (AAMR 18.4), a 2.5:1 ratio. Both periods saw two-phase declines-APCs of ≈ -6.4%/year before 2009-2010 and -3.3 to -3.7%/year thereafter (all p < 0.001). Disparities persisted: Black adults had the highest AAMRs (20.9 weekend; 53.2 weekday), rural rates exceeded urban (28.7 vs. 15.8; 72.0 vs. 40.2), men exceeded women (23.8 vs. 14.0; 60.2 vs. 35.4), and rates rose steeply with age (weekend 0.3-223.0; weekday 0.7-561.0). After 2009, declines slowed, and weekday deaths in Black adults rose after 2018.

Conclusions: The weekend effect on ACS mortality is minimal, with weekday deaths far outnumbering weekend deaths. Persistent-and sometimes widening-disparities by race, rurality, sex, and age highlight the need for equity-focused interventions, strengthened rural cardiac care, and targeted prevention.

Type

Article

PubMed ID

40631895

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