Should hospitals keep cardiac catheterization labs open on weekends?

For patients experiencing non-ST-segment elevation acute coronary syndromes (NSTE-ACS), a rapid invasive strategy (within 24 hours) using coronary angiography and other interventions is beneficial for high-risk as well as low-risk patients. However, this treatment may be constrained on weekends by the need to mobilize on-call catheterization teams. A new study evaluated costs associated with an early versus delayed invasive intervention strategy for patients presenting on weekdays and weekends. Investigators determined that early invasive strategy for Canadian NTSE-ACS patients significantly reduced costs, even on weekends, because of resulting shorter length of hospital stays (LOS).

According to lead investigator Andre Lamy, MD, MHSc, Population Health Research Institute, and Professor in the Department of Surgery and Department of Clinical Epidemiology, McMaster University, ‘Hospitals that currently tend to delay stable patients in favour of weekday catheterization instead of mobilizing the on-call team for an earlier invasive management of NSTE-ACS patients should consider the latter as the savings from adhering to the timing of an early intervention approach would outweigh additional costs.’

The research team analysed data from 479 Canadian patients from the Timing of Intervention in Acute Coronary Syndromes (TIMACS) multinational trial, which included 238 in the early strategy group and 241 in the delayed strategy group in order to assess the impact from the perspective of the Canadian healthcare system.

By the end of the trial patients who had received a strategy of early coronary angiography and intervention saved CAN $2,938 per patient compared to those who underwent a delayed strategy. These significant savings were driven by lower costs associated with LOS ($9,761 for those who underwent an early strategy compared to $12,569 for delayed; a savings of $2,808), especially in ICU/CCU and ward units. There was no significant difference in cost for study percutaneous coronary interventions, drugs, procedures or diagnostic procedures.

‘The results of our Canadian-led multinational trial shows that early intervention is a cost saving strategy for all patients with acute coronary syndromes. In higher risk patients, early intervention also appears to improve clinical outcomes,’ added TIMACS lead investigator Shamir R. Mehta, MD, MSc, Professor of Medicine, McMaster University, and Director, Interventional Cardiology, Hamilton Health Sciences. EurekAlert