6 ms·

The headline is misleading. The actual study proved that the recorded date of admission to hospital in Ireland with ST-segment elevation myocardial infarction w

The headline is misleading. The actual study proved that the recorded date of admission to hospital in Ireland with ST-segment elevation myocardial infarction was increased on a Sunday and Monday. Increased admissions on a Monday is not that unusual given that people often seek medical attention after the weekend but maybe more surprising is the increase on a Sunday. https://heart.bmj.com/content/109/Suppl_3/A78 https://heart.bmj.com/content/109/Suppl_3/A78

haldujai 3y ago
From the methods section of the abstract: “We excluded post-fibrinolysis patients, patients with old stents, and those who presented more than 24 hours after the onset of pain.”[edit: I misread the PDF version which included multiple abstracts, the methods I’m referring to was from a separate study with the title cutoff, this specific abstract didn’t specify. But from below and table 1 in: https://jamanetwork.com/journals/jama/article-abstract/201406 https://jamanetwork.com/journals/jama/article-abstract/20140... which looked at 68,000 STEMIs, 3.1% presented > 12 hours and 8.4% had an unknown time of symptom onset. Wouldn’t explain the magnitude of effect seen in this study. Circadian effects on STEMI and increased incidence on Monday are not new observations.] Don’t think late presentation STEMIs are that common to begin with for your argument to have logical sense, this is the worst form of a “heart attack”. From this single center study presentations > 12 hours only comprised 10%. https://www.ingentaconnect.com/content/wk/jcarm/2017/00000018/00000008/art00001 https://www.ingentaconnect.com/content/wk/jcarm/2017/0000001...
- barbegal 3y ago
  Thanks for links to those extra studies. The 3.1% and 10% presented > 12 hours are averaged across all days of the week not just the Sunday to Monday gap which is likely to be greater given the reduction in public services in Ireland on a Sunday. Do you know of previous studies which report Monday as being particularly risky? I can only find references to time of day (circadian cycle) which obviously make sense given how many bodily processes are linked to a circadian cycle but I'm skeptical about a weekly cycle (which I find confusing to be referred to as circadian also)
  - haldujai 3y ago
    They include an off-hours subgroup which comprises of weekday after hours as well as weekends and represents 2/3rds of cases. They don't provide a further breakdown but in this after-hours group delayed presentation was even lower (2.9%) and they report statistical significance (although it looks like a multivariate P value at a quick glance). Unknown (10%) is hard to interpret what that actually means. Just knowing the pathology of STEMI it's hard to buy that an effect of this size (in the Ireland study) is largely due patient's not seeking care on weekends unless you're somewhere extremely rural as this isn't your average heart attack. If this was about ACS (acute coronary syndrome) in general I'd be more suspicious that patient delays are a relevant confounder, but we have other literature to support the trend (granted with some conflicting studies). from [1]: > Many studies have shown an excess of cardiovascular events on Mondays (1,3,10,16,18,19). A relative trough has been seen on Saturdays and Sundays I compared with the expected number of cases. A similar pattern was seen in most subgroups irrespective of age, gender, cardiac medication, and in-fart characteristics (first or recurrent, Q or non-Q, site). The frequency of morning infarction is greater during the working week than on weekends, suggesting a superimposition of work-related stress on endogenous circadian rhythms. >Circadian variation is found on all days of the week including weekends' when the morning peak is less obvious. I haven't looked at the methodology of the cited studies but they include 6 references for your perusal. [0]https://onlinelibrary.wiley.com/doi/abs/10.1002/clc.22 https://onlinelibrary.wiley.com/doi/abs/10.1002/clc.22 [1]https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.4960261103 https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.4960261... [2]https://europepmc.org/article/med/12061302 https://europepmc.org/article/med/12061302
- tgv 3y ago
  What is the effect in this study? The linked article has no info, not even the doi.
  - OJFord 3y ago
    I linked it in another comment, but that's now a flag-hidden thread, so: https://heart.bmj.com/content/109/Suppl_3/A78.abstract https://heart.bmj.com/content/109/Suppl_3/A78.abstract
    - tgv 3y ago
      Thanks for the link. I'm not impressed by the effect at first sight. I certainly wouldn't want to exclude anything based on it. I mean, it's 13% more on Monday, which makes it "significant", but if you subtract the 3.1% you mention, you get close to the Sunday fraction, which isn't significant (p>0.05, which is a lousy statistic anyway). While it looks there's something going on, it's not enough to ignore the effects of data manipulation.
      - haldujai 3y ago
        You're assuming that the 3.1% for > 12 hours is different between weekdays and weekends. While the study you're quoting grouped after-hours with weekends there were less delayed presentations in this subgroup compared to the M-F business hours group. Other weekday numbers will also have delayed presentations included so you can't just "subtract 3.1" from one day and declare statistical insignificance. What you can do is subtract it from every day as we know that 97% of STEMIs present within 12 hours. As this is just an abstract we don't know what the authors did in this particular example but it's not the first study to suggest Mondays have the highest ACS rates.
magicalhippo 3y ago
Staffing tends to be lower on weekends AFAIK, could it be triggered by extra stress from not getting proper care during the weekend? Another possible factor could be the fact that doctors tend to make more mistakes during operations on Fridays compared to start of week.
- haldujai 3y ago
  Not for a STEMI specifically, it’s one of two ECG patterns even a radiologist like me knows how to read. This is a stronger argument for other diseases. Door to balloon target in STEMI is 90 minutes. STEMI centers (this is picked up by EMS and these ambulances are redirected to appropriate centers) have 24/7 cath lab coverage and any major one will have an ER bypass even during afterhours to expedite care. In fact more and more hospitals (and all the major ones) announce a “Code STEMI” overhead either when the ambulance is dispatched or as soon as the ECG showing ST elevations is discovered in triage/ER to activate the team and reduce door-to-balloon time.
  - selimthegrim 3y ago
    How common is it for a non-cardiologist know how to read ECGs? Is it something required in medical school? I heard a critique of Soviet medical training that nonspecialists didn’t know how to read them.
    - OJFord 3y ago
      The basics definitely taught & required of all junior docs (UK) - but it's nuanced, not just a binary 'read an ECG correct or incorrect' - a specialist might spot something someone else doesn't; two specialists might disagree on whether it shows something or not. (And an interested (inherently non-specialist) junior might notice something a bored & rushed specialist doesn't.)
      - antonjs 3y ago
        Seems like the perfect application for some kind of first pass (in the ambulance,even) automated ML diagnostic, given the data is 2D, well characterized, and mostly repeating. Edit: aha--https://www.nature.com/articles/s41467-020-15432-4 https://www.nature.com/articles/s41467-020-15432-4
pixl97 3y ago
>more surprising is the increase on a Sunday. This doesn't seem that surprising to me, or at least I expect we should also see an increase on Saturday. People like to do harder work, like lawn projects on the weekend, and things like drinking that can affect the heart.
- coffeeshopgoth 3y ago
  So the "Sunday Scaries" are real - where you dread going into your toxic job on Monday. Diet and genetics are big contributors to the blockages forming, and the stress sets it off. I had mine (which lead to a double bypass) on a Sunday morning. My job, at the time, was very high stress and I started dreaded going in every Sunday. I could feel panic attacks welling up on Sundays quite often. This is absolutely just opinion, but talking to some other people that were in the hospital with me, it sounded like I definitely wasn't alone in this life experience.
  - prepend 3y ago
    Victor Frankl said in Man’s Search for Meaning: > Sunday neurosis, that kind of depression which afflicts people who become aware of the lack of content in their lives when the rush of the busy week is over and the void within themselves becomes manifest. So it wasn’t so much about dreading the coming week but being still from the previous week and being sad about what they actually accomplished (or didn’t).
    - CobaltFire 3y ago
      Damn, I need to reread that book. I'm struggling with that now; I just retired at 40 and am looking for meaning in my life with that exact issue popping up.
      - prepend 3y ago
        It was the first time I remembered someone describing the small depression one experiences after accomplishing a goal and it was funny because wasn’t something I remember hearing about from others. Mentally, I called if “post-summit malaise.” I suppose it’s a nice problem to have but still uncomfortable. Congratulations on your retirement and hope you get to figure it out and find a new mountain to climb.
treeman79 3y ago
When you’ve had a number of issues over the years at some point, you just have to kind of keep working and go to the ER on your off hours.
dspillett 3y ago
> maybe more surprising is the increase on a Sunday I don't think that seems surprising. People working office jobs through the week go out and drink more on a Friday and Saturday night, and those of a more sporty bent will often push their bodies more at the weekend because that is when they can find the time for longer or multiple training sessions, and it is where you find organised events (the highest proportion of runs are on a Sunday, with the second highest being Saturday).
- interlinked 3y ago
  Aren't sports good for heart?
  - slashdev 3y ago
    Not if you’re on the verge of a heart attack. Also slightly more controversially, I think very vigorous/taxing sport (like marathons) could do more harm than good. Like a u shaped distribution where moderate exercise is the sweet spot.
  - hansvm 3y ago
    They're probably a net positive on average given the reductions in weight and blood pressure and whatnot, but there's a lot of variability, both in short-term trauma and long-term accumulated damage.
  - dspillett 3y ago
    Depends on what state the heart is in to start with.
  - falcor84 3y ago
    Sports are apparently good for the heart in the medium-long term, but can be very taxing (read: dangerous) for the heart while you're actually doing it.
  - elzbardico 3y ago
    In the long run, if you increase your intensity slowly, giving time for your body to build up increased fitness it tends to be mostly positive. But the short-term stress can be fatal if you are already on the verge of a myocardial event.
3minus1 3y ago
Thanks for linking this. I wish the article included actual stats like the scientists expected about 1500 admissions per day, but Sun/Mon had over 1600, while the other days were between 1400 and 1500.
hinkley 3y ago
I wonder how much that diminishes if you control for DST weekend. We already had evidence that the time shift increases heart attacks. I’m planning to just ignore DST this year. I’ll show up a little early for work half the year, and a little late for the rest.
outworlder 3y ago
> but maybe more surprising is the increase on a Sunday. Anxiety due the the looming work week?

haldujai 3y ago

From the methods section of the abstract: “We excluded post-fibrinolysis patients, patients with old stents, and those who presented more than 24 hours after the onset of pain.”[edit: I misread the PDF version which included multiple abstracts, the methods I’m referring to was from a separate study with the title cutoff, this specific abstract didn’t specify. But from below and table 1 in: https://jamanetwork.com/journals/jama/article-abstract/201406 https://jamanetwork.com/journals/jama/article-abstract/20140... which looked at 68,000 STEMIs, 3.1% presented > 12 hours and 8.4% had an unknown time of symptom onset. Wouldn’t explain the magnitude of effect seen in this study. Circadian effects on STEMI and increased incidence on Monday are not new observations.] Don’t think late presentation STEMIs are that common to begin with for your argument to have logical sense, this is the worst form of a “heart attack”. From this single center study presentations > 12 hours only comprised 10%. https://www.ingentaconnect.com/content/wk/jcarm/2017/00000018/00000008/art00001 https://www.ingentaconnect.com/content/wk/jcarm/2017/0000001...

barbegal 3y ago
Thanks for links to those extra studies. The 3.1% and 10% presented > 12 hours are averaged across all days of the week not just the Sunday to Monday gap which is likely to be greater given the reduction in public services in Ireland on a Sunday. Do you know of previous studies which report Monday as being particularly risky? I can only find references to time of day (circadian cycle) which obviously make sense given how many bodily processes are linked to a circadian cycle but I'm skeptical about a weekly cycle (which I find confusing to be referred to as circadian also)
- haldujai 3y ago
  They include an off-hours subgroup which comprises of weekday after hours as well as weekends and represents 2/3rds of cases. They don't provide a further breakdown but in this after-hours group delayed presentation was even lower (2.9%) and they report statistical significance (although it looks like a multivariate P value at a quick glance). Unknown (10%) is hard to interpret what that actually means. Just knowing the pathology of STEMI it's hard to buy that an effect of this size (in the Ireland study) is largely due patient's not seeking care on weekends unless you're somewhere extremely rural as this isn't your average heart attack. If this was about ACS (acute coronary syndrome) in general I'd be more suspicious that patient delays are a relevant confounder, but we have other literature to support the trend (granted with some conflicting studies). from [1]: > Many studies have shown an excess of cardiovascular events on Mondays (1,3,10,16,18,19). A relative trough has been seen on Saturdays and Sundays I compared with the expected number of cases. A similar pattern was seen in most subgroups irrespective of age, gender, cardiac medication, and in-fart characteristics (first or recurrent, Q or non-Q, site). The frequency of morning infarction is greater during the working week than on weekends, suggesting a superimposition of work-related stress on endogenous circadian rhythms. >Circadian variation is found on all days of the week including weekends' when the morning peak is less obvious. I haven't looked at the methodology of the cited studies but they include 6 references for your perusal. [0]https://onlinelibrary.wiley.com/doi/abs/10.1002/clc.22 https://onlinelibrary.wiley.com/doi/abs/10.1002/clc.22 [1]https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.4960261103 https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.4960261... [2]https://europepmc.org/article/med/12061302 https://europepmc.org/article/med/12061302
tgv 3y ago
What is the effect in this study? The linked article has no info, not even the doi.
- OJFord 3y ago
  I linked it in another comment, but that's now a flag-hidden thread, so: https://heart.bmj.com/content/109/Suppl_3/A78.abstract https://heart.bmj.com/content/109/Suppl_3/A78.abstract
  - tgv 3y ago
    Thanks for the link. I'm not impressed by the effect at first sight. I certainly wouldn't want to exclude anything based on it. I mean, it's 13% more on Monday, which makes it "significant", but if you subtract the 3.1% you mention, you get close to the Sunday fraction, which isn't significant (p>0.05, which is a lousy statistic anyway). While it looks there's something going on, it's not enough to ignore the effects of data manipulation.
    - haldujai 3y ago
      You're assuming that the 3.1% for > 12 hours is different between weekdays and weekends. While the study you're quoting grouped after-hours with weekends there were less delayed presentations in this subgroup compared to the M-F business hours group. Other weekday numbers will also have delayed presentations included so you can't just "subtract 3.1" from one day and declare statistical insignificance. What you can do is subtract it from every day as we know that 97% of STEMIs present within 12 hours. As this is just an abstract we don't know what the authors did in this particular example but it's not the first study to suggest Mondays have the highest ACS rates.

magicalhippo 3y ago

Staffing tends to be lower on weekends AFAIK, could it be triggered by extra stress from not getting proper care during the weekend? Another possible factor could be the fact that doctors tend to make more mistakes during operations on Fridays compared to start of week.

haldujai 3y ago
Not for a STEMI specifically, it’s one of two ECG patterns even a radiologist like me knows how to read. This is a stronger argument for other diseases. Door to balloon target in STEMI is 90 minutes. STEMI centers (this is picked up by EMS and these ambulances are redirected to appropriate centers) have 24/7 cath lab coverage and any major one will have an ER bypass even during afterhours to expedite care. In fact more and more hospitals (and all the major ones) announce a “Code STEMI” overhead either when the ambulance is dispatched or as soon as the ECG showing ST elevations is discovered in triage/ER to activate the team and reduce door-to-balloon time.
- selimthegrim 3y ago
  How common is it for a non-cardiologist know how to read ECGs? Is it something required in medical school? I heard a critique of Soviet medical training that nonspecialists didn’t know how to read them.
  - OJFord 3y ago
    The basics definitely taught & required of all junior docs (UK) - but it's nuanced, not just a binary 'read an ECG correct or incorrect' - a specialist might spot something someone else doesn't; two specialists might disagree on whether it shows something or not. (And an interested (inherently non-specialist) junior might notice something a bored & rushed specialist doesn't.)
    - antonjs 3y ago
      Seems like the perfect application for some kind of first pass (in the ambulance,even) automated ML diagnostic, given the data is 2D, well characterized, and mostly repeating. Edit: aha--https://www.nature.com/articles/s41467-020-15432-4 https://www.nature.com/articles/s41467-020-15432-4

pixl97 3y ago

>more surprising is the increase on a Sunday. This doesn't seem that surprising to me, or at least I expect we should also see an increase on Saturday. People like to do harder work, like lawn projects on the weekend, and things like drinking that can affect the heart.

coffeeshopgoth 3y ago
So the "Sunday Scaries" are real - where you dread going into your toxic job on Monday. Diet and genetics are big contributors to the blockages forming, and the stress sets it off. I had mine (which lead to a double bypass) on a Sunday morning. My job, at the time, was very high stress and I started dreaded going in every Sunday. I could feel panic attacks welling up on Sundays quite often. This is absolutely just opinion, but talking to some other people that were in the hospital with me, it sounded like I definitely wasn't alone in this life experience.
- prepend 3y ago
  Victor Frankl said in Man’s Search for Meaning: > Sunday neurosis, that kind of depression which afflicts people who become aware of the lack of content in their lives when the rush of the busy week is over and the void within themselves becomes manifest. So it wasn’t so much about dreading the coming week but being still from the previous week and being sad about what they actually accomplished (or didn’t).
  - CobaltFire 3y ago
    Damn, I need to reread that book. I'm struggling with that now; I just retired at 40 and am looking for meaning in my life with that exact issue popping up.
    - prepend 3y ago
      It was the first time I remembered someone describing the small depression one experiences after accomplishing a goal and it was funny because wasn’t something I remember hearing about from others. Mentally, I called if “post-summit malaise.” I suppose it’s a nice problem to have but still uncomfortable. Congratulations on your retirement and hope you get to figure it out and find a new mountain to climb.

treeman79 3y ago

When you’ve had a number of issues over the years at some point, you just have to kind of keep working and go to the ER on your off hours.

dspillett 3y ago

> maybe more surprising is the increase on a Sunday I don't think that seems surprising. People working office jobs through the week go out and drink more on a Friday and Saturday night, and those of a more sporty bent will often push their bodies more at the weekend because that is when they can find the time for longer or multiple training sessions, and it is where you find organised events (the highest proportion of runs are on a Sunday, with the second highest being Saturday).

interlinked 3y ago
Aren't sports good for heart?
- slashdev 3y ago
  Not if you’re on the verge of a heart attack. Also slightly more controversially, I think very vigorous/taxing sport (like marathons) could do more harm than good. Like a u shaped distribution where moderate exercise is the sweet spot.
- hansvm 3y ago
  They're probably a net positive on average given the reductions in weight and blood pressure and whatnot, but there's a lot of variability, both in short-term trauma and long-term accumulated damage.
- dspillett 3y ago
  Depends on what state the heart is in to start with.
- falcor84 3y ago
  Sports are apparently good for the heart in the medium-long term, but can be very taxing (read: dangerous) for the heart while you're actually doing it.
- elzbardico 3y ago
  In the long run, if you increase your intensity slowly, giving time for your body to build up increased fitness it tends to be mostly positive. But the short-term stress can be fatal if you are already on the verge of a myocardial event.

3minus1 3y ago

Thanks for linking this. I wish the article included actual stats like the scientists expected about 1500 admissions per day, but Sun/Mon had over 1600, while the other days were between 1400 and 1500.

hinkley 3y ago

I wonder how much that diminishes if you control for DST weekend. We already had evidence that the time shift increases heart attacks. I’m planning to just ignore DST this year. I’ll show up a little early for work half the year, and a little late for the rest.

outworlder 3y ago

> but maybe more surprising is the increase on a Sunday. Anxiety due the the looming work week?