Abstract 4370507: Increased Mortality and Complication Rates in Weekend Admissions for Acute Decompensated Heart Failure

Background: The "weekend effect," marked by higher mortality and complications for weekend hospital admissions, is established for myocardial infarction and stroke but understudied in acute decompensated heart failure (ADHF). Reduced staffing and delayed interventions may contribute. We examined this phenomenon in ADHF using a national cohort. Research Question: Are weekend admissions for ADHF associated with higher mortality and complication rates? Methods: We conducted a retrospective cohort study using the 2016–2020 Nationwide Inpatient Sample. Adult ADHF admissions were identified via ICD-10 codes and stratified by weekend versus weekday admission. Over 30 variables, including age, sex, and comorbidities (e.g., diabetes, hypertension), were analyzed. We applied 1:1 propensity score matching, yielding 489,204 patients per group, and used univariate and multivariate logistic regression to assess outcomes, adjusting for key covariates. Results: Of 2,131,915 ADHF hospitalizations, 501,076 (23.5%) occurred on weekends. The cohort was 48% female, with a mean age of 72 years (SD ± 12.3). Following 1:1 matching, weekend admissions showed higher odds of cardiac arrest (aOR: 1.10; 95% CI: 1.06–1.13, p < 0.001) and inpatient mortality (aOR: 1.07; 95% CI: 1.05–1.09, p < 0.001), alongside elevated risks of acute kidney injury (aOR; 1.07; 95% CI: 1.06–1.08) and acute respiratory failure (aOR: 1.28; 95% CI: 1.27–1.30). No differences emerged in mechanical circulatory support use (11,933 cases total) or length of stay (mean 6.89 days, SD ± 7.6). Weekday admissions incurred higher total hospital charges, likely due to more procedural interventions. Conclusion: Weekend ADHF admissions were associated with a 7–10% higher risk of mortality and complications, potentially due to fewer specialists or delayed diagnostics. These findings underscore the need for standardized ADHF protocols to ensure equitable care across all days. Further research should validate and address these disparities.