I've read a bit into this subject before; Matthew Walker's book 'Why We Sleep'[0] discusses it at length.
A lot of it boils down to blood pressure. High blood pressure is a serious contributing factor to cardiovascular incidents (as well as a slew of other negative health risks), and getting a good night's sleep will help keep blood pressure down. This is also why the amount of heart attacks are up around 24% after daylight savings[1]; an hour less sleep means higher blood pressure means higher risk of heart attack (relative to any other 'normal' day).
I can definitely see how the same logic could apply to Mondays. Less sleep, more stress = higher blood pressure = higher risk of heart attacks.
The important consideration here is that these people are on the cusp of death already, and this is typically just the straw that broke the camel's back. You don't get a heart attack from one bad night of sleep, of course, unless there are significant underlying conditions.
High blood pressure is often refereed to as the "silent killer". It's not like these individuals present sick/ill in their daily lives. Basically the only symptoms of high blood pressure are sudden traumatic events like Heart Attack and Stroke. If you meet one of these people hours before their heart attack you often wouldn't describe them as 'on the cusp of death'.
> If you meet one of these people hours before their heart attack you often wouldn't describe them as 'on the cusp of death'.
I disagree. It's not that the symptoms aren't there, but that they have become normalized due to obesity, smoking, etc. being commonplace. Shortness of breath, sleep apnea, feeling weak, upper body tension/pain, etc. are usually present for quite a while in most people before it finally happens. People don't check their blood pressure often enough despite it being so cheap and easy to do.
I see your point, although some of the symptoms are quite subtle. Most people with sleep apnea don't know they have it until they get tested. Same for other symptoms.
What's really normalized is metabolic syndrome. 88% of adult americans have some degree of metabolic dysfunction. High blood pressure, obesity and other ailments are very often a direct result of that. So much so, that the 'normal' range of indicators such as uric acid has been revised and adjusted over the years, because "normal" people had higher levels and still appeared to be fine. Thankfully, we are starting to question that (eg. https://pubmed.ncbi.nlm.nih.gov/24867507/)
First order of business for anyone watching their blood pressure creeping up over the years (even more so if A1C, triglycerides, liver enzymes and uric acid are rising too): cut sugar in all forms. Not just the sugar you personally add to food, not only what's specified as 'added sugar', but all food containing sugar - which is basically all ultra processed foods. It does include sliced bread which is easily broken down into sugar( and is often laced with additional sugar, check ingredients). Leave your sugar 'allowance' to be used by a reasonable amount of fruits.
That may not reverse the problem (although, in my case, it did) but should help tremendously.
>First order of business for anyone watching their blood pressure creeping up over the years: cut sugar in all forms.
No, first order of business is consulting your doctor and/or a nutritionist and otherwise adhering to common sense of having a reasonably balanced nutritional diet.
If your first order of business is taking random advice from the intertubez, you have bigger problems than high blood pressure.
I mean I get what you're saying. But most doctors have normalized refined sugar intake. Cutting out refined sugar and simple carbs is not harmful at all and carries not risk whatsoever. So I don't see how listening to some modern wisdom in a HN comment is dangerous. Our understanding of nutrition in the western medical theatre is woefully incomplete and outdated.
Sugar is 50% fructose and 50% glucose. The user you mention advocates for a higher amount of fruit which has mostly fructose so my take on this is that he prefers his pancreas over his liver.
I have to agree, while there is a lot of people who say there were no symptoms - it generally was normalized over decades of decline.
It was once I lost 100lb that it became apparent just how bad condition I was in even though at the time I thought I felt fine. It doesn't help when you mention a lack of energy, or poor sleep to the doctor and they just say "Everyone is tired!".
No this is completely wrong. Over the age of 40, a perfectly healthy, functioning and complaint-free individual can have alarmingly high blood pressure. Often it's hereditary. They can even have an obese sibling who's just fine.
Unsure why folks are hating on you. I have had hereditary high BP since I was 13. I was underweight at that point. I was never overweight until COVID. COVID launched me from a normal weight into 'obese' territory pretty fast, but I am now a 'normal' BMI with 9.5% body fat.
This is entirely unrelated to this article and discussion, but something I've been wondering: what makes you say folks are hating on them? Is there a mechanism for downvoting that I'm unaware of?
You’re wrong. A young person with borderline hypertension (130/80) can present in perfect health. Blacks for instance have a genetic predisposition to hypertension, obesity and diet don’t have to be involved. Besides genetics, other health conditions like insomnia or other medications can cause hypertension. Some people are just salt sensitive.
Black African Americans seem to have that predisposition, but not all Black populations do. There is a theory that ability to retain salt improved your odds of surviving a slave ship journey.
The #1 marker you should be checking is blood pressure.
Cholesterol, Fasting Insulin levels, and (if male) free Testosterone are other good ones. Cholesterol and Insulin should be checked by all adults annually, and BP should be checked at least annually. T isn't checked as routinely, but it's worth knowing where you fit and has an impact on your metabolics and the test isn't a big deal.
Buying a cheap little glucose meter is really valuable IMO. You can get them for close to nothing, and you can use them to check your fasting glucose, or your glucose response after meals.
Also, resting heart rate is very easy to measure, especially if you have any kind of fitness/smart watch, and that's a good marker of health too.
I'm a fan of getting lab work done, but it's definitely more of a hassle.
I have high BP due to my insomnia coupled with sleep apnea.
I have insomnia ~5 nights a week. and for some reason I can no longer take naps in my older age. I used to be able to Nap-on-command when I was younger. It SUCKS
> High blood pressure is often refereed to as the "silent killer".
True but checking your blood pressure is painless, basically free and so easy that one can do it at home with no loss of precision.
Speaking as someone with mild high blood pressure, I see people obsess over diets, physical activity, looks, that never go to the doctor or check for their health conditions and "cure" every discomfort/pain with painkillers or ibuprofen.
And they of course all have some advice to give to me to improve my condition based, of course, on some diet they read online or to try yoga or acupuncture (or whatever is fashionable at the moment) and totally ignore the fact that I've been checking my blood pressure for over 20 years, I know a thing or two about it, because doctors. Yeah... I am that crazy! I see doctors!
Once a year is more than enough for people that have never been diagnosed with anything and yet very few people regularly do it, even here in my Country where medical checkups are virtually free.
Yep! You're correct. I didn't mean to imply that they look sickly or anything, just that their body is literally on the verge of failing, even if it looks perfectly fine.
It's actually not very hard to know at all, at least if your question is "what kind of lifestyle will generally lead to the best longterm health outcomes?" Sure, there's minor distinctions to be made and important medical questions, but generally it's pretty clear.
Everyone knows it, I don't need to list it: eating clean, getting good sleep, plenty of exercise, etc.
And furthermore, though our healthcare system seems only configured to deal with things once they become emergencies, metabolic disorder takes your whole life to take root. The time to start making positive changes is now.
This is a very important thing to consider when interpreting this statistic.
"Heart attack rates go up 24% after daylight savings changes" is not the same thing as "There are 24% more heart attacks due to daylight savings". You can't really know the weight of magnitude vs distribution without actually stopping daylight savings.
I feel really good with a sleep rhythm going to bed later each day and getting up later the next day.
I think many people do the same sort of thing, and then monday -- they have to cut their sleep short to get up early and sync with the rest of the world.
I can see how this would be the stressor you allude to.
> In the Northern Hemisphere, the switch to daylight savings time in March results in most people losing an hour of sleep opportunity. Should you tabulate millions of daily hospital records, as researchers have done, you discover that this seemingly trivial sleep reduction comes with a frightening spike in heart attacks the following day. Impressively, it works both ways. In the autumn within the Northern Hemisphere, when the clocks move forward and we gain an hour of sleep opportunity time, rates of heart attacks plummet the day after.
I don't see a specific study cited, but my ebook copy doesn't seem to have all the footnotes.
> The incidence of acute myocardial infarction was significantly increased for the first 3 week-days after the transition to daylight saving time in the spring (Fig. 1A). The incidence ratio for the first week after the spring shift, calculated as the incidence for all 7 days divided by the mean of the weekly incidences 2 weeks before and 2 weeks after, was 1.051 (95% confidence interval [CI], 1.032 to 1.071). In contrast, after the transition out of daylight saving time in the autumn, only the first weekday was affected significantly (Fig. 1B); the incidence ratio for the whole week was 0.985 (95% CI, 0.969 to 1.002
Sure. I'll start by prefacing that I'm not necessarily wholly attributing these as faults of Walker's book. I don't doubt I have a higher propensity for certain anxious responses, or perhaps my personality made me more susceptible to the sort of thinking I'll discuss.
Walker's book—and his accompanying Ted talks and podcasts—instilled a deep sense of sleep anxiety in me, which led to episodes of chronic insomnia (still occurs today). I had never experienced these issues before reading the book. Unfortunately, his message ensures that the insomnia is self-exacerbating, causing a vicious cycle.
Essentially, I find it very wrong for Walker to focus on and overhype the negative aspects of sleep loss as much as he does. Guzey's article [0], also linked above, goes through much of this. Why We Sleep turns into a horror book if you aren't able to sleep for whatever reason. It implies that, from just one bad night's sleep,
1. your immune system will deteriorate significantly
2. the chance that you develop a cancer will increase
3. your mental health will suffer
4. you are more likely to develop anxiety or depression
5. the probability you hurt yourself will increase
6. your mental faculties will be destroyed, you will be unable to reason well
7. you are at higher risk of mortality (!)
8. you are literally closer to death, which the book supports by mentioning fatal familial insomnia (FFI)... a flawed analogy
... and much more.
I was initially ok after reading the book, but the problems really started after I had a bad nights' sleep. I was absolutely terrified the following night, remembering all the awful things that will happen to my body and mind if I do not recuperate the next night. And we all know how easy it is to lose sleep when you are worried. I stayed up until 6 AM that night. Every passing hour made it harder to sleep.
Naturally, this started a cycle. Grumpy and even more anxious the next day ("two days? wow, am I now DOUBLE the chance of cancer and depression?"), sleep began evading me more and more often. The bed became a place of anxiety. Every minute I spent awake, I remembered Walker's book and the terrible things he told me was happening to my body due to the insomnia. This caused an infernal, unending loop of insomnia. Morning birdsong became hell to my ears.
I still sometimes suffer from it to this day, but Guzey's essay really helped. I think some quotes can do my point more justice:
> Your essay on Why we sleep - I can’t thank you enough. I’m a sleep doctor in Oregon and have seen many many patients who have developed severe sleep anxiety and insomnia. Two friends in the sleep field and myself weekly have talked about people that slept well until reading this book.
> I wanted to drop you a line to thank you for all the time and effort involved in debunking Matthew Walker’s book. As someone who works with individuals with insomnia on a daily basis, I know from firsthand experience the harm that Walker’s book is causing. I have many stories of people who slept well on less than eight hours of sleep, read Walker’s book, tried to get more sleep and this led to more time awake, frustration, worry, sleep-related anxiety, and insomnia.
> My patients are coming to me after reading this alarmist book, with insomnia that they did not have before, and worse, harder to treat because although the book has caused these anxieties - they can’t shake their newly built alarmist beliefs they learnt from the very same book.
> Scott slept well his entire life until he listened to a podcast that led him to worry about how much sleep he was getting and the health consequences of insufficient sleep. That night, Scott had a terrible night of sleep and this triggered a vicious cycle of ever-increasing worry about sleep and increasingly worse sleep that lasted for ten months.
I had the same experience. Very often, I couldn't fall asleep until 6-7am. I felt like I was losing my mind. I got professional help from sleep psychologists but it didn't do much. They told me all the same stuff that comes up when you google it, and it terrified me even more that even professionals didn't know why I couldn't sleep. I never had this much of a problem sleeping before I read the book.
After a year of this, a therapist pointed out that you can have bad days on good sleep and good days on bad sleep. That finally made it click that it wasn't logical to worry about bad sleep so much. I just stopped caring and that mostly got me over it, but I still have more bad nights than I ever used to.
If I see people reading the book, I warn them about it even though it feels a bit rude to tell someone not to read something.
I went through a similar thing where I had some trouble sleeping due to external stressors and then started to get freaked out that I was having trouble sleeping, having always been a great sleeper. I developed a lot of anxiety around it and it was pretty awful, though I'm mostly over it now. To me, the key was accepting that I might sleep poorly and being okay with that. That true acceptance allowed me to relax. (The larger context for me fwiw is trying to overcome my perfectionism.)
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
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/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%.
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)
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.
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.
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.
> 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).
There has to be an Internet Law that nothing is surprising - whether it is true or false. Every statement, true or false, has an explanation for why it is true.
Yes, but that law isn’t surprising. The internet brings such a wide variety of life experience and education into the same discussion that there is always someone for whom the statement is obvious given their life experience.
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.
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.
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.
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.
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.
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.
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.)
Agree in general, even if one knew this at one point or know the textbook appearances patients don't read textbooks and there's nuance to everything. Unless you're actively exposed to/interpreting ECGs in clinical practice you lose the skill.
When I was an intern I was 100x better than I am at this point in my career.
The basic atrial fibrillation and STEMI is something any doctor can interpret with confidence (I used myself as an example as I'm probably the least competent because I haven't looked at an ECG in 10 years). I doubt non-cardiac surgeons are much better on average as they don't really look at these themselves that often other than for basic things.
An ER or general internal medicine physician is expected to be competent in more advanced but common stuff like bundle branch blocks, left ventricular hypertrophy, non ST elevated MI.
Weird arrhythmias or conduction abnormalities is really only for cardiologists, and even then typically a subspecialist electrophysiologist.
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.
We've had computer-reads/AI on ECGs since I was a medical student. Really good at detecting normal, bad at everything else.
US/Can healthcare systems still pay a cardiologist a couple of bucks to "finalize" the interpretation whenever they get around to it. It's a bit ironic, someone could have an MI on Friday, get treated and discharged and we're still paying someone on the Monday to read 40 ECGs (note these would have been acutely interpreted by the cardiologist treating the patient, most places have rules against self-referrals so you can't formally interpret anything you order yourself).
My wife is a nurse, and they definitely learned how to read ECGs in nursing school, and she later worked in a cardiac ICU where she got additional training. She couldn't read a 12 lead and notice all the things that a cardiologist would, but for STEMIs and a few others she was trained to recognize them and call a code.
Your wife would be more skilled than the vast majority of surgeons and radiologists at this as she looks at rhythm strips them way more than we do, and none of these physicians would hesitate to admit this.
Honestly, when I have an ICU nurse providing procedural sedation for me I essentially just defer to their expertise on the rhythms and if they're worried I activate the mobile response team.
> Honestly, when I have an ICU nurse providing procedural sedation for me I essentially just defer to their expertise on the rhythms and if they're worried I activate the mobile response team.
That matches with my impression about a lot of things in her job. I'm always a little surprised when she talks about calling the doctor saying I need X, Y and Z and the doctor just being like cool I'll put in the order. Obviously, not all doctors are like that but it seems like the vast majority defer to the nurses in a lot of situations. This is completely different than the conception I had of healthcare before I met her.
I love working with ICU nurses. Generally speaking they are are very competent and very much respect their scope (both physicians and nurses overstepping is a recipe for disaster) so it's an incredibly healthy and collaborative relationship.
> I'm always a little surprised when she talks about calling the doctor saying I need X, Y and Z and the doctor just being like cool I'll put in the order.
This is the best part. A lot of decisions like sleeping aids, antipsychotics, antiemetics don't have evidence to choose from the various options so it's a bit of trial and error. An ICU nurse typically covers 1-2 patients and knows them very well, so if the recommend/ask for something it's usually the right decision and reduces the cognitive burden on the physician. We obviously still do a safety/sanity check but ballpark estimate I'd say I disagree or order something else < 5% of the time.
Similarly I'd say the proportion of bullshit overnight pages (e.g. I fondly remember a 4am call that a patient has leg cramps) I've received from ICU nurses are even less than that.
General ward nurses on the other hand... A very heterogeneous bunch with high turnover (worse in academia, at my last hospital average career length was ~2 years before they leave for greener pastures) so the relationship is very different.
Not that I don't appreciate them or their work, but far less trust in decision making and they need more oversight.
I'm not sure what you practice but that's far too dismissive. I passed med school just fine and maintain my ACLS certification as required. Am I calling an AV block or even a STEMI in real life? Absolutely not.
I maintain enough competence to know when it looks like it could be critical so I can call for help, but realistically that's happening anyway as soon as someone gets unstable as I haven't resuscitated someone in years.
I haven't looked at a real patient's ECG in probably 7 years now. If you were the patient, would you even want me to? I'd rather just do the smart and safe thing, call for help.
No subspecialist (or even specialist) can maintain competence in all areas of medicine, it's hard enough keeping up my general radiology skills. It's a good thing none of us practice in silos by definition.
The statement I made was if you can't read a critical ECG then you failed medical school.
You have basically agreed with me.
I made no statements about subspecialisation or attempt to reconcile the breadth of medical knowledge that is required as you progress through medical training into consultant status with that original knowledge, or implied that we're expected to be able to definitively diagnose and manage a patient with a ECG that implies an imminent threat to life.
Frankly I think that everyone should still be able to recognise a STEMI - it's pretty characteristic; the more severe or subtle AV blocks definitely take some familiarity; but the bedrock principle of ACLS is calling for help, and medicine is certainly a team sport
Apologies, I misunderstood your point. I thought you were criticizing that I can't read every ECG pattern in ACLS (what I assumed you meant by critical).
any recommendations for a crash course in cardiology for the motivated learner? (randomly searching the internet being really inefficient for this type of targeted learning. motivated, as in, diagnosed with a significant coronary artery blockage.)
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.
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.
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).
I have read it, and yes, this is true...but I actually had a boss that would just demean you in front of anyone and every so often threw a chair, so my stress was coming from multiple fronts.
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.
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.
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.
I definitely felt Mondays on-call were much busier in the hospital. I always thought this could be due to patients spending weekends with family, not wanting to cause a fuss and maybe ignoring symptoms of cardiac chest pain until it evolves into a serious heart attack (STEMI). Also, they may be waiting to see their GP on Monday morning and then get referred to hospital (although less likely with STEMIs).
I also remember the time between Christmas and New Year being very busy - I thought for a similar reason - people understandably just don't want to be in hospital for Christmas.
Maybe for some of them, but I think a lot of people eat worse and drink more on holidays/weekends. A lot of people with dangerously high blood sugar around holidays and a lot of older folks get/report UTIs.
Yep, it will be interesting to see – Apple Watch can already monitor for atrial fibrillation: https://support.apple.com/en-gb/HT212214. Though, it looks like the patient must already have a diagnosis from a doctor. So rather than diagnosing, it's sort of an AF tracker - which is useful as AF can come and go.
The problem obviously with heart attacks is the implications of false negatives and positives are huge, and the tracing from a watch would be less reliable than the gold-standard ECG / EKG.
I don't believe it uses the EKG functionality to detect afib. I think it's just using some sort of machine learning on the data coming from the photoplethysmograph sensor (now that's a word I had to look up to remember the correct spelling for). Basically the sensor that takes your pulse.
The EKG, as far as I know, doesn't really tell you much other than whether it thinks you have a normal sinus rhythm, or something it doesn't recognize. Too fast, too slow, or whatever. It's also on demand, not continuous. You have to touch a finger from your opposite hand to the crown, while the EKG app is running.
Also, that Kardia advertising is borderline scam. It's a 1 lead EKG just like the Apple Watch. Six lead my ass, they make that claim because you can contort your body in enough ways to take readings from each standard EKG location. You can sorta do the same thing with an apple watch, though it's not physically as large so it wouldn't be as easy. What rubs me the wrong way about calling the Kardia a 6-lead EKG is that it cannot do 6-leads simultaneously, and I think that is a critical detail.
I had a Kardia myself before the first Apple Watch with EKG came out.
The "very clear about the fact it cannot detect a heart attack" thing is so obnoxious that it actually kinda breaks that app. If you got a messy/noisy EKG reading and want to do it again, you have to carefully scrooll to the bottom of the page and click done. Or you accidentally tap the large grey box at the top that takes you to a multi-page legal explanation of how it's not meant to detect a heart attack - and that page has a teeny tiny button at the top left to take you back to the last page.
An anecdote that supports this: I was just in the emergency department and asked them why it was so quiet on the weekend. They said many people wait until Monday to seek treatment for whatever reason.
Could rule out certain things. If they have more heart attacks on Sunday, then it would make it more likely that the association is "first day of the work week," as opposed to something like "first day of trading on international markets" (only Monday).
Side note: there is also a stress-induced heart problem called tako-tsubo cardiomyopathy (aka 'broken-heart syndrome'), which also seems to be more common on Mondays.
It's caused by sudden stress (e.g. bereavement, illness) which leads to weakening of the heart muscle, causing the heart to bulge out at the apex. It's named 'tako-tsubo' because the heart starts to resemble a round vessel used in Japan to catch octopuses.
I dont know about bulging but when I experienced my first break up in the 20s, I literally felt a hole in my heart for many days. It was a surreal experience, for some reason my mind was just telling me that there is nothing there where my heart should be.
I can't help but notice the poor air quality here on the US east coast today and wonder if any of the link can be explained by the exposure to pollutants due to commuting. It took me years to piece together that my chronic sinus issues and occasional heart palpitations were connected. Too much post nasal drip would end up filling my lungs with phlegm, leading to symptoms not all that different than COPD. It's not hard to imagine someone in poorer health having the same reaction in closer to real time on a Monday morning.
Is this similar to the story that it rains more on the weekend ? Didn't the analysis show that if you segmented the data into arbitrary chunks it always came back with higher rainfall at the start of end of the period - so if you broken the data up into blocks that went from Wednesday -> Tuesday it would come back and say it rains most on Wednesday. Wonder if something like that is going on here - I am down with the argument about stress and going back to work making it worse on a Monday :)
Since Mondays are always three days after Fridays, it's pretty clear there is a correlation, the only real question is what's happening on the Fridays, and why would they try to hide that?
(I know I’ll get downvoted for using humor on HN, the “this isn’t Reddit no smiling” brigade will be here in a moment to express their scorn at any sign of pleasure)
Low value comments get downvotes - and most “funny” comments are about a zero on the funny scale (regardless that office space is fantastic).
The point of the guidelines is to help reduce low value comments and on that note - mentioning voting is against the guidelines https://news.ycombinator.com/newsguidelines.html for the same reason “Please don't comment about the voting on comments. It never does any good, and it makes boring reading.”
It's not humor in general that's disliked, it's seeing the same few dozen tired references that it's seen as normal to repeat ad nauseum on more social media type sites like reddit.
That said, Office Space is my favorite movie so don't take it personally, mmkay? Yeahh, that'd be great.
The issue isn't humor, it's that people overestimate how funny their comments are. The best explanation of this was from scott_s years ago: https://news.ycombinator.com/item?id=7609289.
Also, a surprising amounts of heart attacks are during sex. But I think the number one killer is shoveling snow! Basically any physical exertion for people who don't normally do physical exertion.
I'd bet that probably alcohol and the consequent dehydration are one of the big drivers here.
People severely underestimate how much alcohol can dehydrate someone.
I once worked in a computer lab for a graveyard shift on the weekend (midnight to 10am).
One early Sunday morning the clock started making noise. Chunk. Chunk. Chunk. Chunk. Moving the minute hand rapidly. It kept going and going and going.
The clock can only go forward. In order to set the time back 1 hour it had to advance the clock 23 hours, one minute at a time.
This also confused payroll when I handed in my time sheet.
12:00 AM - 3:00 AM (3h)
2:00 AM - 10:00 AM (8h)
They also had trouble when I did
12:00 AM - 10:00 AM (9h)
But they figured that it was going to be easier to just pay me an extra hour ($7.50 then) than it would have been to try to correct it.
> Schools traditionally used wired clock systems for two basic reasons: rock solid reliability and the ability to synchronize school bells to the rest of the system. The wired synchronized system ensured that clocks would all read the same time and bells would ring at the same time every day, no matter what classroom you were in, and that students would arrive to class on time — something teachers could only dream of before installing a synchronized system.
Used to wonder why more hospital patients had critical episodes at night. My brother-in-law who's worked hospitals all his life, said simply "the night shift is on"
I'm going to presume the OP was hinting at people working night shifts are more sleep deprived, and thus more accident prone, causing the increase in emergency room visits.
I think total disconnection on weekends cause more stress on Mondays and that's why most people hate them, you need a lot more cognitive effort to resume work.
Alternate theory: most deadly heart attacks are reported on a Monday, because that's when the admin assistant tasked with doing the paperwork gets around to clearing out the backlog. And since most reports don't include the actual time of death, Monday 08:02 it will be...
Do you honestly think people on dying on a Saturday and it's being logged as a Monday morning death because of the admin assistant? That's insane, and has no basis in reality.
It would be unusual that they use reporting date vs date of death. The date of death is pretty normally distributed [0]. So while the reporting date probably piles up on Mondays, that’s not very useful for studying.
Well, I certainly changed my mind now! Sorry, that was sarcasm, I know this isn't Reddit... Anyway: so I tried to track down the actual paper being presented (since the linked article, of course, does not cite that). No luck. Lots of clickbait re-peats and re-re-peats. But I guess you have the link and will gladly provide it?
Thanks! This still seems to be just an abstract, though, and I was unable to find any details about the actual method of data collection. Been downvoted enough for today, though, so...
I think that and the figures might be 'it' since it was presented at the mentioned conference, i.e. either a poster (which wouldn't necessarily ever be published in that form) or an oral presentation (which I guess might just be discussion & slides around the abstract, without anything more than that being written up? Or perhaps to follow - it is dated as 5-7th, i.e. ongoing at time of writing.)
I've read a bit into this subject before; Matthew Walker's book 'Why We Sleep'[0] discusses it at length.
A lot of it boils down to blood pressure. High blood pressure is a serious contributing factor to cardiovascular incidents (as well as a slew of other negative health risks), and getting a good night's sleep will help keep blood pressure down. This is also why the amount of heart attacks are up around 24% after daylight savings[1]; an hour less sleep means higher blood pressure means higher risk of heart attack (relative to any other 'normal' day).
I can definitely see how the same logic could apply to Mondays. Less sleep, more stress = higher blood pressure = higher risk of heart attacks.
[0] https://www.goodreads.com/book/show/34466963-why-we-sleep
[1] https://pubmed.ncbi.nlm.nih.gov/18971502/
The important consideration here is that these people are on the cusp of death already, and this is typically just the straw that broke the camel's back. You don't get a heart attack from one bad night of sleep, of course, unless there are significant underlying conditions.
High blood pressure is often refereed to as the "silent killer". It's not like these individuals present sick/ill in their daily lives. Basically the only symptoms of high blood pressure are sudden traumatic events like Heart Attack and Stroke. If you meet one of these people hours before their heart attack you often wouldn't describe them as 'on the cusp of death'.
> If you meet one of these people hours before their heart attack you often wouldn't describe them as 'on the cusp of death'.
I disagree. It's not that the symptoms aren't there, but that they have become normalized due to obesity, smoking, etc. being commonplace. Shortness of breath, sleep apnea, feeling weak, upper body tension/pain, etc. are usually present for quite a while in most people before it finally happens. People don't check their blood pressure often enough despite it being so cheap and easy to do.
I see your point, although some of the symptoms are quite subtle. Most people with sleep apnea don't know they have it until they get tested. Same for other symptoms.
What's really normalized is metabolic syndrome. 88% of adult americans have some degree of metabolic dysfunction. High blood pressure, obesity and other ailments are very often a direct result of that. So much so, that the 'normal' range of indicators such as uric acid has been revised and adjusted over the years, because "normal" people had higher levels and still appeared to be fine. Thankfully, we are starting to question that (eg. https://pubmed.ncbi.nlm.nih.gov/24867507/)
First order of business for anyone watching their blood pressure creeping up over the years (even more so if A1C, triglycerides, liver enzymes and uric acid are rising too): cut sugar in all forms. Not just the sugar you personally add to food, not only what's specified as 'added sugar', but all food containing sugar - which is basically all ultra processed foods. It does include sliced bread which is easily broken down into sugar( and is often laced with additional sugar, check ingredients). Leave your sugar 'allowance' to be used by a reasonable amount of fruits.
That may not reverse the problem (although, in my case, it did) but should help tremendously.
>First order of business for anyone watching their blood pressure creeping up over the years: cut sugar in all forms.
No, first order of business is consulting your doctor and/or a nutritionist and otherwise adhering to common sense of having a reasonably balanced nutritional diet.
If your first order of business is taking random advice from the intertubez, you have bigger problems than high blood pressure.
> a nutritionist
In most places, any bozo can claim to be a nutritionist. From what I can tell, a large proportion of them are deranged crackpots.
So, no. Absolutely do not consult a self-described nutritionist.
I mean I get what you're saying. But most doctors have normalized refined sugar intake. Cutting out refined sugar and simple carbs is not harmful at all and carries not risk whatsoever. So I don't see how listening to some modern wisdom in a HN comment is dangerous. Our understanding of nutrition in the western medical theatre is woefully incomplete and outdated.
What makes sugar different from other carbohydrates?
It's really quick fuel that leads to an insulin spike that triggers more fat storage and eventually leads to insulin resistance.
Sugar is 50% fructose and 50% glucose. The user you mention advocates for a higher amount of fruit which has mostly fructose so my take on this is that he prefers his pancreas over his liver.
Eating whole fruit means you consume fiber at the same time as the sugar, so the latter is metabolized more safely.
Eating whole cake means you consume fat at the same time as the sugar, so the latter is metabolized more safely.
Could you liquidize the cake and still get that benefit?
I have to agree, while there is a lot of people who say there were no symptoms - it generally was normalized over decades of decline.
It was once I lost 100lb that it became apparent just how bad condition I was in even though at the time I thought I felt fine. It doesn't help when you mention a lack of energy, or poor sleep to the doctor and they just say "Everyone is tired!".
No this is completely wrong. Over the age of 40, a perfectly healthy, functioning and complaint-free individual can have alarmingly high blood pressure. Often it's hereditary. They can even have an obese sibling who's just fine.
Unsure why folks are hating on you. I have had hereditary high BP since I was 13. I was underweight at that point. I was never overweight until COVID. COVID launched me from a normal weight into 'obese' territory pretty fast, but I am now a 'normal' BMI with 9.5% body fat.
This is entirely unrelated to this article and discussion, but something I've been wondering: what makes you say folks are hating on them? Is there a mechanism for downvoting that I'm unaware of?
You’re wrong. A young person with borderline hypertension (130/80) can present in perfect health. Blacks for instance have a genetic predisposition to hypertension, obesity and diet don’t have to be involved. Besides genetics, other health conditions like insomnia or other medications can cause hypertension. Some people are just salt sensitive.
Black African Americans seem to have that predisposition, but not all Black populations do. There is a theory that ability to retain salt improved your odds of surviving a slave ship journey.
What makers can I check?
The #1 marker you should be checking is blood pressure.
Cholesterol, Fasting Insulin levels, and (if male) free Testosterone are other good ones. Cholesterol and Insulin should be checked by all adults annually, and BP should be checked at least annually. T isn't checked as routinely, but it's worth knowing where you fit and has an impact on your metabolics and the test isn't a big deal.
Buying a cheap little glucose meter is really valuable IMO. You can get them for close to nothing, and you can use them to check your fasting glucose, or your glucose response after meals.
Also, resting heart rate is very easy to measure, especially if you have any kind of fitness/smart watch, and that's a good marker of health too.
I'm a fan of getting lab work done, but it's definitely more of a hassle.
I have high BP due to my insomnia coupled with sleep apnea.
I have insomnia ~5 nights a week. and for some reason I can no longer take naps in my older age. I used to be able to Nap-on-command when I was younger. It SUCKS
Here’s a spectrum:
- “on the cusp of death already”
- Normalized ill-health
There are some things in between those two.
> High blood pressure is often refereed to as the "silent killer".
True but checking your blood pressure is painless, basically free and so easy that one can do it at home with no loss of precision.
Speaking as someone with mild high blood pressure, I see people obsess over diets, physical activity, looks, that never go to the doctor or check for their health conditions and "cure" every discomfort/pain with painkillers or ibuprofen.
And they of course all have some advice to give to me to improve my condition based, of course, on some diet they read online or to try yoga or acupuncture (or whatever is fashionable at the moment) and totally ignore the fact that I've been checking my blood pressure for over 20 years, I know a thing or two about it, because doctors. Yeah... I am that crazy! I see doctors!
Once a year is more than enough for people that have never been diagnosed with anything and yet very few people regularly do it, even here in my Country where medical checkups are virtually free.
IMO the real silent killer is indolence.
Yep! You're correct. I didn't mean to imply that they look sickly or anything, just that their body is literally on the verge of failing, even if it looks perfectly fine.
My cousin ran marathons, ate well, etc. and died in his sleep of a heart attack or more likely cardiac arrest.
On the flip side, isn't it also likely that repeating the same stressful behavior pattern over years (decades?) results in this outcome?
However, parsing signal from noise does seem a very difficult proposition.
It's actually not very hard to know at all, at least if your question is "what kind of lifestyle will generally lead to the best longterm health outcomes?" Sure, there's minor distinctions to be made and important medical questions, but generally it's pretty clear.
Everyone knows it, I don't need to list it: eating clean, getting good sleep, plenty of exercise, etc.
And furthermore, though our healthcare system seems only configured to deal with things once they become emergencies, metabolic disorder takes your whole life to take root. The time to start making positive changes is now.
This is where an intervention-based study shines. It's just basically impossible to design an intervention for this one.
(But then, this also means that knowing it for sure would be useless.)
This is a very important thing to consider when interpreting this statistic.
"Heart attack rates go up 24% after daylight savings changes" is not the same thing as "There are 24% more heart attacks due to daylight savings". You can't really know the weight of magnitude vs distribution without actually stopping daylight savings.
or by conducting some causal inference with a load of identification assumptions
While presumably true in the general case, there are many drugs etc that drastically lower peoples risks of dying from a heart attack.
So many people must get quite close to a heart attack only to live a long life and die of something else.
I feel really good with a sleep rhythm going to bed later each day and getting up later the next day.
I think many people do the same sort of thing, and then monday -- they have to cut their sleep short to get up early and sync with the rest of the world.
I can see how this would be the stressor you allude to.
It's so much better going to sleep and waking up the same time every day.
The only problem is it's often incompatible with a social life when you're in your 20s, but thankfully I'm not in my 20s anymore.
This is because our circadian rhythms are naturally found to be about 25 hours absent external stimuli or timekeeping devices.
This is also why the amount of heart attacks are up around 24% after daylight savings[1]; an hour less sleep means higher blood pressure
There is no proof of this as to why. Only that it happens. For example:
* the hour of lost sleep does not happen on Monday, but on Sunday morning
* people could sleep in on Monday, then get hyper stressed that they are late
* type A personalities could get mad at an office of sluggish people
* people could get upset at everyone complaining about DST again, my blood pressure went up at your post!
This book has serious issues. https://guzey.com/books/why-we-sleep/ The only mention of daylight savings time in Why We Sleep is:
> In the Northern Hemisphere, the switch to daylight savings time in March results in most people losing an hour of sleep opportunity. Should you tabulate millions of daily hospital records, as researchers have done, you discover that this seemingly trivial sleep reduction comes with a frightening spike in heart attacks the following day. Impressively, it works both ways. In the autumn within the Northern Hemisphere, when the clocks move forward and we gain an hour of sleep opportunity time, rates of heart attacks plummet the day after.
I don't see a specific study cited, but my ebook copy doesn't seem to have all the footnotes.
I pulled up the article you linked on sci-hub: https://sci-hub.se/https://pubmed.ncbi.nlm.nih.gov/18971502/ The only use of the number "24" refers to hours in the day, and its summary doesn't seem to match your claim:
> The incidence of acute myocardial infarction was significantly increased for the first 3 week-days after the transition to daylight saving time in the spring (Fig. 1A). The incidence ratio for the first week after the spring shift, calculated as the incidence for all 7 days divided by the mean of the weekly incidences 2 weeks before and 2 weeks after, was 1.051 (95% confidence interval [CI], 1.032 to 1.071). In contrast, after the transition out of daylight saving time in the autumn, only the first weekday was affected significantly (Fig. 1B); the incidence ratio for the whole week was 0.985 (95% CI, 0.969 to 1.002
Personal anecdote--I fucking hate this book.
For many reasons, I slept just fine until I read it.
Would love to hear more
Sure. I'll start by prefacing that I'm not necessarily wholly attributing these as faults of Walker's book. I don't doubt I have a higher propensity for certain anxious responses, or perhaps my personality made me more susceptible to the sort of thinking I'll discuss.
Walker's book—and his accompanying Ted talks and podcasts—instilled a deep sense of sleep anxiety in me, which led to episodes of chronic insomnia (still occurs today). I had never experienced these issues before reading the book. Unfortunately, his message ensures that the insomnia is self-exacerbating, causing a vicious cycle.
Essentially, I find it very wrong for Walker to focus on and overhype the negative aspects of sleep loss as much as he does. Guzey's article [0], also linked above, goes through much of this. Why We Sleep turns into a horror book if you aren't able to sleep for whatever reason. It implies that, from just one bad night's sleep,
... and much more.I was initially ok after reading the book, but the problems really started after I had a bad nights' sleep. I was absolutely terrified the following night, remembering all the awful things that will happen to my body and mind if I do not recuperate the next night. And we all know how easy it is to lose sleep when you are worried. I stayed up until 6 AM that night. Every passing hour made it harder to sleep.
Naturally, this started a cycle. Grumpy and even more anxious the next day ("two days? wow, am I now DOUBLE the chance of cancer and depression?"), sleep began evading me more and more often. The bed became a place of anxiety. Every minute I spent awake, I remembered Walker's book and the terrible things he told me was happening to my body due to the insomnia. This caused an infernal, unending loop of insomnia. Morning birdsong became hell to my ears.
I still sometimes suffer from it to this day, but Guzey's essay really helped. I think some quotes can do my point more justice:
> Your essay on Why we sleep - I can’t thank you enough. I’m a sleep doctor in Oregon and have seen many many patients who have developed severe sleep anxiety and insomnia. Two friends in the sleep field and myself weekly have talked about people that slept well until reading this book.
> I wanted to drop you a line to thank you for all the time and effort involved in debunking Matthew Walker’s book. As someone who works with individuals with insomnia on a daily basis, I know from firsthand experience the harm that Walker’s book is causing. I have many stories of people who slept well on less than eight hours of sleep, read Walker’s book, tried to get more sleep and this led to more time awake, frustration, worry, sleep-related anxiety, and insomnia.
> My patients are coming to me after reading this alarmist book, with insomnia that they did not have before, and worse, harder to treat because although the book has caused these anxieties - they can’t shake their newly built alarmist beliefs they learnt from the very same book.
> Scott slept well his entire life until he listened to a podcast that led him to worry about how much sleep he was getting and the health consequences of insufficient sleep. That night, Scott had a terrible night of sleep and this triggered a vicious cycle of ever-increasing worry about sleep and increasingly worse sleep that lasted for ten months.
[0]: https://guzey.com/books/why-we-sleep
I had the same experience. Very often, I couldn't fall asleep until 6-7am. I felt like I was losing my mind. I got professional help from sleep psychologists but it didn't do much. They told me all the same stuff that comes up when you google it, and it terrified me even more that even professionals didn't know why I couldn't sleep. I never had this much of a problem sleeping before I read the book.
After a year of this, a therapist pointed out that you can have bad days on good sleep and good days on bad sleep. That finally made it click that it wasn't logical to worry about bad sleep so much. I just stopped caring and that mostly got me over it, but I still have more bad nights than I ever used to.
If I see people reading the book, I warn them about it even though it feels a bit rude to tell someone not to read something.
If it helps I have heard that his book is poorly researched
I went through a similar thing where I had some trouble sleeping due to external stressors and then started to get freaked out that I was having trouble sleeping, having always been a great sleeper. I developed a lot of anxiety around it and it was pretty awful, though I'm mostly over it now. To me, the key was accepting that I might sleep poorly and being okay with that. That true acceptance allowed me to relax. (The larger context for me fwiw is trying to overcome my perfectionism.)
Thanks for the write-up
[dead]
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
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/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/2017/0000001...
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)
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 [1]https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.4960261... [2]https://europepmc.org/article/med/12061302
What is the effect in this study? The linked article has no info, not even the doi.
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
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.
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.
> 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).
There has to be an Internet Law that nothing is surprising - whether it is true or false. Every statement, true or false, has an explanation for why it is true.
Yes, but that law isn’t surprising. The internet brings such a wide variety of life experience and education into the same discussion that there is always someone for whom the statement is obvious given their life experience.
Aren't sports good for heart?
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.
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.
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.
Depends on what state the heart is in to start with.
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.
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.
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.
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.
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.)
Agree in general, even if one knew this at one point or know the textbook appearances patients don't read textbooks and there's nuance to everything. Unless you're actively exposed to/interpreting ECGs in clinical practice you lose the skill.
When I was an intern I was 100x better than I am at this point in my career.
The basic atrial fibrillation and STEMI is something any doctor can interpret with confidence (I used myself as an example as I'm probably the least competent because I haven't looked at an ECG in 10 years). I doubt non-cardiac surgeons are much better on average as they don't really look at these themselves that often other than for basic things.
An ER or general internal medicine physician is expected to be competent in more advanced but common stuff like bundle branch blocks, left ventricular hypertrophy, non ST elevated MI.
Weird arrhythmias or conduction abnormalities is really only for cardiologists, and even then typically a subspecialist electrophysiologist.
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
We've had computer-reads/AI on ECGs since I was a medical student. Really good at detecting normal, bad at everything else.
US/Can healthcare systems still pay a cardiologist a couple of bucks to "finalize" the interpretation whenever they get around to it. It's a bit ironic, someone could have an MI on Friday, get treated and discharged and we're still paying someone on the Monday to read 40 ECGs (note these would have been acutely interpreted by the cardiologist treating the patient, most places have rules against self-referrals so you can't formally interpret anything you order yourself).
My wife is a nurse, and they definitely learned how to read ECGs in nursing school, and she later worked in a cardiac ICU where she got additional training. She couldn't read a 12 lead and notice all the things that a cardiologist would, but for STEMIs and a few others she was trained to recognize them and call a code.
Your wife would be more skilled than the vast majority of surgeons and radiologists at this as she looks at rhythm strips them way more than we do, and none of these physicians would hesitate to admit this.
Honestly, when I have an ICU nurse providing procedural sedation for me I essentially just defer to their expertise on the rhythms and if they're worried I activate the mobile response team.
> Honestly, when I have an ICU nurse providing procedural sedation for me I essentially just defer to their expertise on the rhythms and if they're worried I activate the mobile response team.
That matches with my impression about a lot of things in her job. I'm always a little surprised when she talks about calling the doctor saying I need X, Y and Z and the doctor just being like cool I'll put in the order. Obviously, not all doctors are like that but it seems like the vast majority defer to the nurses in a lot of situations. This is completely different than the conception I had of healthcare before I met her.
I love working with ICU nurses. Generally speaking they are are very competent and very much respect their scope (both physicians and nurses overstepping is a recipe for disaster) so it's an incredibly healthy and collaborative relationship.
> I'm always a little surprised when she talks about calling the doctor saying I need X, Y and Z and the doctor just being like cool I'll put in the order.
This is the best part. A lot of decisions like sleeping aids, antipsychotics, antiemetics don't have evidence to choose from the various options so it's a bit of trial and error. An ICU nurse typically covers 1-2 patients and knows them very well, so if the recommend/ask for something it's usually the right decision and reduces the cognitive burden on the physician. We obviously still do a safety/sanity check but ballpark estimate I'd say I disagree or order something else < 5% of the time.
Similarly I'd say the proportion of bullshit overnight pages (e.g. I fondly remember a 4am call that a patient has leg cramps) I've received from ICU nurses are even less than that.
General ward nurses on the other hand... A very heterogeneous bunch with high turnover (worse in academia, at my last hospital average career length was ~2 years before they leave for greener pastures) so the relationship is very different.
Not that I don't appreciate them or their work, but far less trust in decision making and they need more oversight.
If you can’t read a critical ECG you failed medical school
I'm not sure what you practice but that's far too dismissive. I passed med school just fine and maintain my ACLS certification as required. Am I calling an AV block or even a STEMI in real life? Absolutely not.
I maintain enough competence to know when it looks like it could be critical so I can call for help, but realistically that's happening anyway as soon as someone gets unstable as I haven't resuscitated someone in years.
I haven't looked at a real patient's ECG in probably 7 years now. If you were the patient, would you even want me to? I'd rather just do the smart and safe thing, call for help.
No subspecialist (or even specialist) can maintain competence in all areas of medicine, it's hard enough keeping up my general radiology skills. It's a good thing none of us practice in silos by definition.
The statement I made was if you can't read a critical ECG then you failed medical school.
You have basically agreed with me. I made no statements about subspecialisation or attempt to reconcile the breadth of medical knowledge that is required as you progress through medical training into consultant status with that original knowledge, or implied that we're expected to be able to definitively diagnose and manage a patient with a ECG that implies an imminent threat to life.
Frankly I think that everyone should still be able to recognise a STEMI - it's pretty characteristic; the more severe or subtle AV blocks definitely take some familiarity; but the bedrock principle of ACLS is calling for help, and medicine is certainly a team sport
Apologies, I misunderstood your point. I thought you were criticizing that I can't read every ECG pattern in ACLS (what I assumed you meant by critical).
All good!
any recommendations for a crash course in cardiology for the motivated learner? (randomly searching the internet being really inefficient for this type of targeted learning. motivated, as in, diagnosed with a significant coronary artery blockage.)
>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.
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.
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).
I have read it, and yes, this is true...but I actually had a boss that would just demean you in front of anyone and every so often threw a chair, so my stress was coming from multiple fronts.
God, these days I'd love that. Record it and you have the perfect 'hostile work environment suit'.
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.
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.
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.
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.
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.
> but maybe more surprising is the increase on a Sunday.
Anxiety due the the looming work week?
I definitely felt Mondays on-call were much busier in the hospital. I always thought this could be due to patients spending weekends with family, not wanting to cause a fuss and maybe ignoring symptoms of cardiac chest pain until it evolves into a serious heart attack (STEMI). Also, they may be waiting to see their GP on Monday morning and then get referred to hospital (although less likely with STEMIs).
I also remember the time between Christmas and New Year being very busy - I thought for a similar reason - people understandably just don't want to be in hospital for Christmas.
Maybe for some of them, but I think a lot of people eat worse and drink more on holidays/weekends. A lot of people with dangerously high blood sugar around holidays and a lot of older folks get/report UTIs.
I wonder if there is expectation of not getting help on weekend and thus time and energy would be wasted on traveling to hospital?
I wonder if modern smartphones lay the groundwork for people knowing they're on the cusp of a heart attack.
E.g., using sensors that are cheap, and are less invasive than EKG electrodes. Kinda like the way Apple watches can now continuously monitor stuff
Yep, it will be interesting to see – Apple Watch can already monitor for atrial fibrillation: https://support.apple.com/en-gb/HT212214. Though, it looks like the patient must already have a diagnosis from a doctor. So rather than diagnosing, it's sort of an AF tracker - which is useful as AF can come and go.
The problem obviously with heart attacks is the implications of false negatives and positives are huge, and the tracing from a watch would be less reliable than the gold-standard ECG / EKG.
Does an Apple Watch actually tell you if you are?
It monitors for atrial fibrilation using a single leak EKG I think.
It is very clear about the fact it cannot detect a heart attack though.
Then there’s these slightly more sophisticated things: https://store.kardia.com/products/kardiamobile6l
I don't believe it uses the EKG functionality to detect afib. I think it's just using some sort of machine learning on the data coming from the photoplethysmograph sensor (now that's a word I had to look up to remember the correct spelling for). Basically the sensor that takes your pulse.
The EKG, as far as I know, doesn't really tell you much other than whether it thinks you have a normal sinus rhythm, or something it doesn't recognize. Too fast, too slow, or whatever. It's also on demand, not continuous. You have to touch a finger from your opposite hand to the crown, while the EKG app is running.
Also, that Kardia advertising is borderline scam. It's a 1 lead EKG just like the Apple Watch. Six lead my ass, they make that claim because you can contort your body in enough ways to take readings from each standard EKG location. You can sorta do the same thing with an apple watch, though it's not physically as large so it wouldn't be as easy. What rubs me the wrong way about calling the Kardia a 6-lead EKG is that it cannot do 6-leads simultaneously, and I think that is a critical detail.
I had a Kardia myself before the first Apple Watch with EKG came out.
Kardia has both the single lead body contortion thing and their 6-lead version, which has 3 metal plates and does a lot more at the same time.
It’s not like you should expect it to be a full EKG :P
The "very clear about the fact it cannot detect a heart attack" thing is so obnoxious that it actually kinda breaks that app. If you got a messy/noisy EKG reading and want to do it again, you have to carefully scrooll to the bottom of the page and click done. Or you accidentally tap the large grey box at the top that takes you to a multi-page legal explanation of how it's not meant to detect a heart attack - and that page has a teeny tiny button at the top left to take you back to the last page.
> it cannot detect a heart attack though
Perhaps the watch can detect deadly heart attacks (stopped heartbeat)? Although I’m not sure how much use that feature would be.
An anecdote that supports this: I was just in the emergency department and asked them why it was so quiet on the weekend. They said many people wait until Monday to seek treatment for whatever reason.
Probably varies by hospital and area but things like imagining departments being closed might factor in to that. England here.
More than once a relative has been admitted on a Saturday and is just observed until Monday when the full diagnostics are available (eg MRI).
It would be really interesting to see whether this holds in Middle Eastern countries or other places where the work week starts on a Sunday.
Why, though? A name is just a name, and that also holds for weekdays.
Could rule out certain things. If they have more heart attacks on Sunday, then it would make it more likely that the association is "first day of the work week," as opposed to something like "first day of trading on international markets" (only Monday).
Side note: there is also a stress-induced heart problem called tako-tsubo cardiomyopathy (aka 'broken-heart syndrome'), which also seems to be more common on Mondays.
It's caused by sudden stress (e.g. bereavement, illness) which leads to weakening of the heart muscle, causing the heart to bulge out at the apex. It's named 'tako-tsubo' because the heart starts to resemble a round vessel used in Japan to catch octopuses.
https://en.wikipedia.org/wiki/Takotsubo_cardiomyopathy
> causing the heart to bulge out at the apex.
I dont know about bulging but when I experienced my first break up in the 20s, I literally felt a hole in my heart for many days. It was a surreal experience, for some reason my mind was just telling me that there is nothing there where my heart should be.
I can't help but notice the poor air quality here on the US east coast today and wonder if any of the link can be explained by the exposure to pollutants due to commuting. It took me years to piece together that my chronic sinus issues and occasional heart palpitations were connected. Too much post nasal drip would end up filling my lungs with phlegm, leading to symptoms not all that different than COPD. It's not hard to imagine someone in poorer health having the same reaction in closer to real time on a Monday morning.
In my experience post nasal drip shouldn't make it into your lungs, that sounds like a more serious problem.
I'm not going to post my complete medical history on the internet, but suffice it to say I have some complicating factors.
Is this similar to the story that it rains more on the weekend ? Didn't the analysis show that if you segmented the data into arbitrary chunks it always came back with higher rainfall at the start of end of the period - so if you broken the data up into blocks that went from Wednesday -> Tuesday it would come back and say it rains most on Wednesday. Wonder if something like that is going on here - I am down with the argument about stress and going back to work making it worse on a Monday :)
Since Mondays are always three days after Fridays, it's pretty clear there is a correlation, the only real question is what's happening on the Fridays, and why would they try to hide that?
Sorry I missed the joke. Why is that the case?
This contradicts some data released by 'The Cure'. Tuesday and Wednesday look much more risky.
However 'The Boomtown Rats' seem to agree with the study.
Looks like someone has a case of the Mondays!
(I know I’ll get downvoted for using humor on HN, the “this isn’t Reddit no smiling” brigade will be here in a moment to express their scorn at any sign of pleasure)
Low value comments get downvotes - and most “funny” comments are about a zero on the funny scale (regardless that office space is fantastic).
The point of the guidelines is to help reduce low value comments and on that note - mentioning voting is against the guidelines https://news.ycombinator.com/newsguidelines.html for the same reason “Please don't comment about the voting on comments. It never does any good, and it makes boring reading.”
It's not humor in general that's disliked, it's seeing the same few dozen tired references that it's seen as normal to repeat ad nauseum on more social media type sites like reddit.
That said, Office Space is my favorite movie so don't take it personally, mmkay? Yeahh, that'd be great.
Yeah I actually have never used Reddit so don’t know. I’m more a Usenet guy.
The issue isn't humor, it's that people overestimate how funny their comments are. The best explanation of this was from scott_s years ago: https://news.ycombinator.com/item?id=7609289.
Also, a surprising amounts of heart attacks are during sex. But I think the number one killer is shoveling snow! Basically any physical exertion for people who don't normally do physical exertion.
A lot of speculation here. Here’s a link to the actual study: https://heart.bmj.com/content/heartjnl/109/Suppl_3/A78.full....
They don’t break it down by age which might help show if it’s work related.
Heart attacks are also clearly elevated on Sundays, and not depressed on Saturdays, which might suggest this is related to alcohol.
I'd bet that probably alcohol and the consequent dehydration are one of the big drivers here. People severely underestimate how much alcohol can dehydrate someone.
Work stress man, it'll kill you
Thank goodness it's Tuesday!
Deadly heart attacks are also more common on days when the clocks go forward. It’s to do with lack of sleep, apparently.
> when the clocks go forward
I had a moment trying to figure out when the clocks moved backwards before I remembered DST is a thing.
I once worked in a computer lab for a graveyard shift on the weekend (midnight to 10am).
One early Sunday morning the clock started making noise. Chunk. Chunk. Chunk. Chunk. Moving the minute hand rapidly. It kept going and going and going.
The clock can only go forward. In order to set the time back 1 hour it had to advance the clock 23 hours, one minute at a time.
This also confused payroll when I handed in my time sheet.
They also had trouble when I did But they figured that it was going to be easier to just pay me an extra hour ($7.50 then) than it would have been to try to correct it.A better solution would be to have the clock turn itself off, wait an hour, and then turn itself back on again.
This was a centrally controlled clock. When the master clock sent a pulse, all the clocks would advance 1 minute.
These were synchronized wired clocks ( https://www.natsco.net/industries-served/industries-served-o... /// https://blog.american-time.com/wireless-master-time-clock-vs... ).
> Schools traditionally used wired clock systems for two basic reasons: rock solid reliability and the ability to synchronize school bells to the rest of the system. The wired synchronized system ensured that clocks would all read the same time and bells would ring at the same time every day, no matter what classroom you were in, and that students would arrive to class on time — something teachers could only dream of before installing a synchronized system.
In other words, work is literally killing us due to Sunday night syndrome and stress we are unaware of.
Used to wonder why more hospital patients had critical episodes at night. My brother-in-law who's worked hospitals all his life, said simply "the night shift is on"
not entirely sure what this comment is saying. Night shift workers not as effective? Can someone spell it out for me?
I'm going to presume the OP was hinting at people working night shifts are more sleep deprived, and thus more accident prone, causing the increase in emergency room visits.
I'd be curious to know if these heart attacks happen equally in those that have to work from home vs those who have to commute to an office.
or equally in those that are retired
This feels like something i’m going to log into the ‘why do i know this’ section of memory.
I think total disconnection on weekends cause more stress on Mondays and that's why most people hate them, you need a lot more cognitive effort to resume work.
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I would cynically suspect: existential dread
Anything except another week with this lot
Thank god its Tuesday!
Work is stressful
A case of the Mondays?
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Alternate theory: most deadly heart attacks are reported on a Monday, because that's when the admin assistant tasked with doing the paperwork gets around to clearing out the backlog. And since most reports don't include the actual time of death, Monday 08:02 it will be...
Do you honestly think people on dying on a Saturday and it's being logged as a Monday morning death because of the admin assistant? That's insane, and has no basis in reality.
It would be unusual that they use reporting date vs date of death. The date of death is pretty normally distributed [0]. So while the reporting date probably piles up on Mondays, that’s not very useful for studying.
[0] https://www.cdc.gov/nchs/data/dvs/table14_99.pdf (in the US at least)
Do you have any evidence for any of the claims here?
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Well, I certainly changed my mind now! Sorry, that was sarcasm, I know this isn't Reddit... Anyway: so I tried to track down the actual paper being presented (since the linked article, of course, does not cite that). No luck. Lots of clickbait re-peats and re-re-peats. But I guess you have the link and will gladly provide it?
Here you go: https://heart.bmj.com/content/109/Suppl_3/A78.abstract
(I searched 'Laffan cardio monday' on Google Scholar, Laffan was quoted as lead author in OP.)
Your argument at least in its current form seems not to hold - there's higher incidence over the weekend too.
Thanks! This still seems to be just an abstract, though, and I was unable to find any details about the actual method of data collection. Been downvoted enough for today, though, so...
I think that and the figures might be 'it' since it was presented at the mentioned conference, i.e. either a poster (which wouldn't necessarily ever be published in that form) or an oral presentation (which I guess might just be discussion & slides around the abstract, without anything more than that being written up? Or perhaps to follow - it is dated as 5-7th, i.e. ongoing at time of writing.)