Heart attacks in December — why are the holidays the most dangerous time for the heart?

Aim of the study: To study circadian rhythm aspects, national holidays, and major sports events as triggers of myocardial infarction.

Results: Christmas and Midsummer holidays were associated with a higher risk of myocardial infarction (incidence rate ratio 1.15, 95% confidence interval 1.12 to 1.19, P<0.001, and 1.12, 1.07 to 1.18, P<0.001, respectively). The highest associated risk was observed for Christmas Eve (1.37, 1.29 to 1.46, P<0.001). No increased risk was observed during Easter holiday or sports events. A circaseptan and circadian variation in the risk of myocardial infarction was observed, with higher risk during early mornings and on Mondays. Results were more pronounced in patients aged over 75 and those with diabetes and a history of coronary artery disease. In this nationwide real world study covering 16 years of hospital admissions for myocardial infarction with symptom onset documented to the nearest minute, Christmas, and Midsummer holidays were associated with higher risk of myocardial infarction, particularly in older and sicker patients, suggesting a role of external triggers in vulnerable individuals.

Aim of the study: Objectives: Christmas holidays have been associated with the highest incidence of myocardial infarction (MI). We wanted to assess possible triggers of MI during Christmas.

Results: 43%, p = .031). There were no increases in quarrels, anger, economic worries, or reduced compliance with medication. Conclusions: Patients suffering MI on Christmas holiday experienced higher levels of stress and emotional distress compared to patients with chronic coronary syndrome, possibly contributing to the phenomenon of holiday heart attack. Understanding what factors increase the number of MI on Christmas may help reduce the excess number of MIs and cardiovascular burden.

Aim of the study: Previous analyses have suggested that factors that stimulate the sympathetic nervous system and catecholamine release can trigger acute myocardial infarction. The wake-up time, Mondays, winter season, physical exertion, emotional upset, overeating, lack of sleep, cocaine, marijuana, anger, and sexual activity are some of the more common triggers.

Results: A number of hypotheses have been raised to explain the increase in cardiac events during the holidays, including overeating, excessive use of salt and alcohol, exposure to particulates, from fireplaces, a delay in seeking medical help, anxiety or depression related to the holidays, and poorer staffing of health care facilities at this time. War has been associated with an increase in cardiac events. Data regarding an increase in cardiac events during the 9/11 terrorist attack have been mixed. Understanding the cause of cardiovascular triggers will help in developing potential therapies.

Aim of the study: Objectives: Out-of-hour admission (on weekends, holidays, and weekday nights) has been associated with higher mortality in patients with acute myocardial infarction (AMI). We conducted a meta-analysis to verify the association between out-of-hour admission and mortality (both short- and long-term) in AMI patients.

Results: Out-of-hour admission was also associated with significantly increased long-term mortality (OR 1.03; 95%CI 1.01-1.04; I 2 = 66.6%), with no statistical indication of publication bias (p = 0.207). In the exploratory subgroup analysis, the intervention effect for short-term mortality was pronounced among patients in different regions (p = 0.04 for interaction) and socio-economic levels (p = 0.007 for interaction) and long-term mortality was pronounced among patients with different type of AMI (p = 0.0008 for interaction) or on different types of out-to-hour admission (p = 0.006 for interaction). Conclusion: Out-of-hour admission may be associated with an increased risk of both short- and long-term mortality in AMI patients. Trial Registration: PROSPERO (CRD42020182364).

Aim of the study: To examine the effects of holiday and weekend admission on in-hospital mortality for patients with acute myocardial infarction (AMI) in China.

Results: Compared to non-holiday and weekday admissions, holiday and weekend admissions, respectively, were associated with increases in risk-adjusted mortality rates. Chinese National Day was associated with an additional 10 deaths per 1000 admissions (95% confidence interval (CI): (0, 20))-a relative increase from baseline mortality of 64% (95% CI: (1%, 128%)). Sunday was associated with an additional 4 deaths per 1000 admissions (95% CI: (0, 7))-a relative increase from baseline mortality of 23% (95% CI: (3%, 45%)). We found no evidence of gender differences in holiday or weekend effects on mortality. Holiday and weekend admissions were associated with in-hospital AMI mortality. The admissions on Chinese National Day and Sunday contributed to the observed "holiday effect" and "weekend effect," respectively.

Aim of the study: Patients admitted to acute care hospitals on weekends have poorer outcomes than those admitted on weekdays, and patients admitted to hospitals for acute myocardial infarction (AMI) on weekends have a higher mortality rate than those admitted during the week. Very few studies have examined weekend presentation for patients with AMI with respect to mortality in the emergency department (ED).

Results: A total of 1,343 patients with a diagnosis of AMI presented to 73 EDs in New Jersey. Of these, 382 (28%) presented on a weekend/holiday and 961 (72%) during weekday hours. After propensity score matching and using probit regression, weekend/holiday presentation was significantly associated with mortality (b = 0.30, 95% CI [0.03, 0.57]). Other statistically significant covariates include patient age (b = 0.03, 95% CI [0.02, 0.04], hospital technology status (b = 0.75, 95% CI [0.20, 1.30]), and nurse staffing (b = -0.08, 95% CI [-0.13, -0.04]).

Aim of the study: The higher incidence of myocardial infarction (MI) during national holidays could be caused by overindulgence of food and beverages, potentially straining the heart of vulnerable individuals. Monitoring decreased thoracic impedance by cardiac implantable electronic devices (CIED) can be used for detection of fluid accumulation. We aimed to assess the relationship between cardiac metrics and national holidays in patients with CIED.

Results: Patients with CIED-based impedance monitoring at a tertiary care hospital in Sweden were screened. Patients were included if they had data for at least one holiday (Christmas, New Year, or Midsummer) between June 2015 and January 2020. Thoracic impedance, heart rate variability, and activity during the holiday were compared with baseline values, defined as the average of 3 days preceding Christmas and Midsummer. Clinical characteristics were obtained from medical records. In total, 96 patients (82% men, age 69 ± 10 years, 92% ICD, 78% CRT, 72% with LVEF < 40%) were included, which provided data for 649 patient-holidays. During Christmas Day, New Year's Day, and Midsummer Day combined, impedance decreased by a mean of 1.1 Ohm [95% CI 0.7-1.6, P < 0.001], heart rate variability decreased by a mean of 8.0 ms [4.9-11.2, P > 0.001] and daily activity by a mean of 40 min [35-45, P < 0.001]. One ventricular tachycardia event requiring shock therapy was documented during the holiday.

Aim of the study: To 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.

Results: Long-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).

Aim of the study: Although acute myocardial infarction (AMI) remains a leading cause of death in Mexico, the impact of out-of-hours presentation on mortality remains understudied. The aim of this study was to evaluate the association between out-of-hours admissions (nights, weekends, holidays) and 30-day mortality in patients with AMI in Mexican hospitals, with a focus on the role of catheterization laboratories (cath lab).

Results: The study included a total of 29 131 cases: 4515 in percutaneous coronary intervention (PCI)-capable centers (group 1) and 24 616 in non-PCI-capable centers (group 2). Admissions outside regular hours accounted for 46.7% in group 1 and 53.6% in group 2. Adjusted analysis showed that although the presence of a cath lab was protective (HR, 0.25; 95%CI, 0.23-0.28), admissions outside regular hours increased the risk of mortality in both groups (group 1: HR, 1.25; 95%CI, 1.04-1.50; group 2: HR, 1.16; 95%CI, 1.11-1.22). Although overnight shifts increased the risk of death in both groups, weekends and holidays increased such risk only in non-PCI-capable centers. Out-of-hours admissions were associated with higher mortality, and unlike in developed countries, the presence of a cath lab did not improve out-of-hours outcomes.