Stroke care organization overcomes the deleterious ‘weekend effect’ on 1‐month stroke mortality: a population‐based study

Abstract

Background and purpose Suffering a stroke during the weekend is associated with a poorer prognosis. The impact of implementing a dedicated stroke care network in Dijon, France, in 2003 on 30‐day mortality in strokes/transient ischaemic attacks (TIA) occurring during weekends/bank holidays was evaluated. Methods All cases of stroke and TIA from 1985 to 2010 were identified from a population‐based registry, using multiple overlapping sources of information. Demographics and clinical data were recorded. Cox regression models were used to evaluate associations between day of onset (weekdays versus weekends/bank holidays) and 30‐day all‐cause mortality. Data were stratified according to time periods [before (1985–2003) and after (2004–2010) implementation of the stroke network] and stroke subtypes (ischaemic stroke and intracerebral hemorrhage). Results Of the 5864 recorded patients, 1465 (25%) had their event during weekends/bank holidays. Patients with stroke/TIA during weekdays were comparable with those with stroke/TIA during weekends/bank holidays for baseline characteristics. Excess mortality was observed in patients with stroke/TIA during weekends/bank holidays during 1985–2003 (18.2% vs. 14.0%, P < 0.01) but not during 2004–2010 (8.4% vs. 8.3%, P = 0.74). Onset during weekends/bank holidays was associated with a higher risk of 30‐day mortality during 1985–2003 (adjusted hazard ratio 1.26; 95% CI 1.06–1.51, P = 0.01), but not during 2004–2010 (adjusted hazard ratio 0.99; 95% CI 0.69–1.43, P = 0.97). Conclusion The deleterious effect of weekends/bank holidays on early stroke mortality disappeared after the organization of a dedicated stroke care network in our community. Our findings provide strong support for the implementation of quality improvement initiatives in order to attenuate inequalities in the management of stroke patients.