Stroke patients may get more aggressive care on weekends

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Patients who suffer a stroke on the weekends may receive more aggressive care in hospitals compared with those who have a stroke on a weekday, according to new research published in the Archives of Neurology. Drawing on previous research that suggested that heart attack patients admitted on weekends may not receive the same quality of care as those who enter the hospital on Saturday or Sunday, researchers from the Medical University of South Carolina, Charleston, set out to analyze whether there was any gap in quality of care across the week for stroke patients. In an analysis of more than 70,000 patients admitted to Virginia hospitals between 1998 and 2006 with acute ischemic stroke (AIS)—the type of stroke that represents nearly 80% of all strokes, and is characterized by reduced blood flow to the brain caused by clots or narrowed arteries—researchers found that, while death rates were comparable among patients admitted either on weekends or weekdays, those who came in on Saturday or Sunday were more likely to be given a clot-busting medication known as tissue plasminogen activator (t-PA).

First approved by the Food and Drug Administration in 1996, t-PA needs to be administered within the first three hours of the first symptoms of stroke in order to be effective, and, when successfully administered, has been shown to reduce debilitating long-term effects of stroke, such as numbness, or loss of speech. Yet, though the researchers point out that AIS is the leading cause of death and disability in the U.S., the vast majority of people—more than 95%—who suffer from strokes do not receive t-PA.

While, overall, few weekend or weekday AIS patients were given t-PA—roughly 1% of the entire study population received the medication—those admitted on the weekend were about 20% more likely to be given the drug compared with those who entered the hospital during the week. Researchers suggest that this difference may have to do with the fact that patients face fewer hurdles getting to the hospital on weekends—no rush hour traffic—and may be more likely to arrive within the three-hour time frame. Another possibility for why stroke patients may get more aggressive treatment on weekends, they write, is that there are fewer elective surgeries scheduled on weekends, meaning that patients admitted with an emergency may not have to wait in line behind previously scheduled procedures, thereby gaining faster access to scans and other tests.

The authors conclude, that, contrary to previous study suggesting inferior quality of care on weekends, not only did patients receive consistently high quality care on Saturday and Sunday, but may even have been given more aggressive treatments than those admitted during the week. While the researchers repeatedly emphasize that more aggressive treatment does not necessarily mean better treatment—pointing to the statistically insignificant differences in death rates between stroke patients admitted at different times of the week—as the study doesn’t assess long-term effects of stroke, it’s difficult to tell whether the equal distribution of “quality” care extends beyond mortality rates. Yet, while what the doctors do once you get to the hospital can be critical to stroke patients’ outcomes, which hospital they go to and how quickly they can get there are also central factors to survival. As the study authors point out, stroke patients who are treated in designated stroke centers are more likely to survive, as are patients who live within a 30-minute drive of a stroke center.

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