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To the Editor: In their study of in-hospital cardiac arrests, Dr Peberdy and colleagues¹ found lower survival rates during nights and weekends. Similarly, patients admitted on weekends for acute myocardial infarction have been found to have a significantly higher mortality compared with patients admitted on weekdays.² Nights and weekends share several potentially harmful factors, such as lower surveillance levels; less availability of trained medical staffing, ancillary personnel, important medical services, and common urgent procedures; and reduced psychophysical performance. This plausible interpretation is mainly focused on the health care workers or structures.

However, circadian or weekly oscillations of endogenous biological rhythms related to the patient or the disease itself may also play a role. Medical emergencies, especially cardiovascular and respiratory, exhibit a circadian variation characterized by a progressive increase in frequency rate during nighttime and a peak soon after awakening,³ with a temporal pattern similar to the hourly rate of survival . . . [Full Text of this Article]

Roberto Manfredini, MD
mfr@unife.it
Vascular Diseases Center
University of Ferrara
Ferrara, Italy

Raffaella Salmi, MD
Department of Internal Medicine
St Anna General Hospital of Ferrara
Ferrara

Fabio Manfredini, MD
Vascular Diseases Center
University of Ferrara

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