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Daniel D. Buff, MD; Jay M. Fleisher, MS; Javier A. Roca, MD; Mossadiq Jaffri, MD; Peter M. Wyrwinski, MD

Arch Intern Med. 1992;152(6):1282-1288.

Abstract
Background.—
A circadian pattern has been convincingly demonstrated for the onset of many outpatient ischemic vascular events. A morning peak exists for the onset of acute myocardial infarction, sudden cardiac death, reversible myocardial ischemia, and ischemic stroke. Data regarding circadian patterns of disease in hospitalized patients, however, are lacking. We examined in-hospital cardiopulmonary arrest (CPA) occurring on the general medical ward to determine if a circadian distribution existed in time of onset.

Methods.—
All CPAs that occurred during a 9-month period and met entry criteria were included for study. The day was divided into 4-hour intervals and analyses were performed for evidence of periodicity in time of onset. The CPAs were then divided into those that were "expected" and those that were "unexpected," and further analyses of periodicity were performed.

Results. —
For the total study population (137 patients), a primary peak frequency of CPA occurred during the interval from 4 to 7:59 AM, and a secondary peak frequency occurred during the 8 to 11:59 PM interval. A minimum frequency occurred during the midnight to 3:59 AM interval. The onset of unexpected CPA peaked during the 4 to 7:59 AM interval, and expected CPA followed no circadian pattern.

Conclusions.—
Our analysis of CPA occurring in patients hospitalized on the general medical ward demonstrated a circadian pattern of onset that favored the early-morning hours. This pattern is predominantly due to unexpected CPA. If further study confirms our observations, changes in the prophylaxis of in-hospital CPA and adjustments in staff responses to its occurrence may be indicated.

(Arch Intern Med. 1992;152:1282-1288)

Author Affiliations
From the Department of Medicine, St John's Episcopal Hospital, Far Rockaway, NY (Drs Buff, Roca, Jaffri, and Wyrwinski); and Department of Preventive Medicine and Community Health, State University of New York Health Science Center at Brooklyn (Mr Fleisher).

Footnotes
Accepted for publication November 16, 1991.

Reprint requests to Department of Medicine, St John's Episcopal Hospital, Far Rockaway, NY 11691 (Dr Buff).

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