If you have ever worried about a drop-off in medical services over the weekend, and that you or your loved one might receive less than optimal care on a Saturday afternoon, well... keep worrying. Having spent more than twenty-five years in emergency rooms, I have had the same concern. Things are just different on the weekend. Some entire departments close down and staffs are reduced. It wasn't that long ago you couldn't get a CT scan done except on weekdays.

Maybe it was just a perception and not the reality. But it seems that other people have been worried about this potential problem. In a recent edition of the New England Journal of Medicine (2007; 356:1099-1109), several researchers looked at this very issue. They studied the outcomes of 59,000 patients admitted to New Jersey hospitals with the diagnosis of an acute heart attack, paying special attention to the day of the week these people were admitted and to their eventual outcomes.

Interestingly, and quite disturbingly, they determined that the risk of death 30 days after a heart attack was 10% greater in people admitted on the weekend. They concluded this was due to several factors, including less use during this time of the week of proven procedures such as cardiac catheterizations and placement of stents.

Their summation included this comment: "Our study suggests that a hospital workweek of Monday through Friday is not optimal for the care of patients with an acute MI (heart attack)."

That's reassuring. So, be sure to get out your calendar and schedule your "big one" for a Monday afternoon, maybe Tuesday.

And while we're talking about heart attacks, here's another interesting piece of information, and something you can use.

Our Russian medical colleagues have clarified an important association between flu outbreaks and the risk of heart attacks and cardiac related deaths. As physicians, we routinely advise elderly patients and those with certain diseases to annually receive their flu vaccinations. These diseases include diabetes, lung diseases, and various forms of heart disease, as well as any problem that might impair your immune system. Some of us may have wondered why heart disease was included in this group.

A study published in the European Heart Journal presented the findings of several researchers from St. Petersburg. These authors looked at data from the St. Petersburg Influenza Research Center for the years 1993-2000. Specifically, they wanted to know the causes of death during flu epidemics during this period. Lest you are suspicious as to the accuracy of these findings, the authors point out that the autopsy rate in this city is more than 70%. That compares with less than 20% in this country.

They discovered some interesting information. There were 9 flu epidemics during these years, and each epidemic was associated with an increase in deaths due to heart disease. This makes sense in that a significant case of influenza can be physically taxing with its associated fever, cough, and fatigue. This is the first large study that really connects the dots.

They also learned that this increased risk begins two weeks before and lasts two weeks after the peak of the epidemic. Something to be aware of. And next year, when you're debating whether or not to get your flu shot, keep this in mind, especially if you or a family member has a history of heart disease.

Lastly, here's some information concerning one of the major risk factors for the development of heart disease: high blood pressure. Current definitions define hypertension as greater than 140/90 for the general population, and greater than 130/80 for individuals with diabetes.

Do you know your blood pressure? If you don't, you're not alone. According to the Journal of Clinical Hypertension almost 70% of people with elevated blood pressure do not know they have it. And incredibly, only 16% of people with known hypertension are treated and adequately controlled.

All of us need to know this number. Depending on our age, family history of medical problems, and our own history of medical problems, this measurement needs to be taken on a regular basis, sometimes as frequently as every three months. This is easy to do, but very important. Don't neglect it.