Observational studyBMJ open2025
Do longer holidays worsen quality of care for patients with STEMI? A retrospective observational study using the nationwide China cardiovascular association database-chest pain centre registry.
Observational study in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo examine whether longer holidays are associated with worse quality of care for patients with ST-segment elevation myocardial infarction (STEMI) compared with weekday admissions and to evaluate the impact of holiday duration on both process indicators and mortality outcomes.
designRetrospective observational study.
settingNationwide study across 3278 hospitals in China participating in the China Cardiovascular Association Database-Chest Pain Centre Registry.
participantsA total of 616 382 STEMI episodes from 1 January 2016 to 31 December 2021 were included. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome was in-hospital mortality. Secondary outcomes included process indicators: initial ECG acquisition within 10 min, thrombolytic treatment within 30 min and door-to-balloon time within 90 min. Admissions were categorised as weekday (reference), weekend, short-term holiday (3-5 days) or long-term holiday (7-10 days).
resultsLong-term holidays were associated with a 10% increased risk of in-hospital mortality (OR=1.10, 95% CI: 1.02 to 1.18, p<0.05), with a 17% increased risk during the Spring Festival (OR=1.17, 95% CI: 1.09 to 1.25, p<0.01). Weekends showed a 5% increased mortality risk (OR=1.05, 95% CI: 1.02 to 1.09, p<0.01). Initial ECG acquisition within 10 min improved during long-term holidays (OR=1.15, 95% CI: 1.10 to 1.21, p<0.001). However, short-term holidays were associated with worse performance for thrombolytic treatment within 30 min (OR=0.83, 95% CI: 0.76 to 0.91, p<0.01) and door-to-balloon time within 90 min (OR=0.83, 95% CI: 0.80 to 0.87, p<0.01). Primary-secondary hospitals showed lower odds of timely percutaneous coronary intervention during long-term holidays (OR=0.83, 95% CI: 0.75 to 0.92, p<0.001), while tertiary hospitals were more affected during short-term holidays (OR=0.82, 95% CI: 0.79 to 0.86, p<0.001).
conclusionsLonger holidays, particularly the Spring Festival, are associated with slightly worse outcomes for patients with STEMI in China. While initial assessments may be expedited during holidays, delays occur in providing definitive treatment. These findings highlight the need for targeted strategies to maintain high-quality STEMI care during extended holiday periods.
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