National Interhospital Transfer for Patients With Acute Cardiovascular Conditions

Abstract

Background Treatment of ST-elevation myocardial infarction (STEMI) in Canada is protocolized, and timely patient transfer can improve outcomes. Population-based processes of care in Canada for other cardiovascular conditions remain less clear. We aimed to describe the interhospital transfer of Canadian patients with acute cardiovascular disease. Methods We reviewed the Canadian Institute for Health Information Discharge Abstract Database for adult patients hospitalized with acute cardiovascular disease between 2013 and 2018. We compared patient characteristics and clinical outcomes based on transfer status (transferred, nontransferred) and presenting hospital (teaching, large community, medium community, and small community hospitals). The primary outcome of interest was in-hospital mortality. Results There were 476,753 patients with primary acute cardiovascular diagnoses, 48,579 (10.2%) of whom were transferred. Transferred patients were more frequently younger, male, and had fewer comorbidities. The most common diagnoses among transferred patients were non-STEMI (44.2%), STEMI (29.0%), and congestive heart failure (9.4%). Using teaching hospitals as a reference, transfer to large and medium community hospitals was associated with lower hospital mortality (adjusted odds ratio: 0.83, 95% confidence interval: 0.75-0.91 and 0.45, 95% confidence interval: 0.39-0.52, respectively). Conclusions Approximately 10% of patients with acute cardiovascular conditions are transferred to another hospital. Patient transfer may be associated with lower in-hospital mortality, with possible variability based on diagnosis, comorbidities, hospital of origin, and destination hospital. Further investigation into the optimization of care for patients with acute cardiovascular disease, including transfer practices, is warranted as regionalized care models continue to develop.

Did inter-hospital transfer reduce mortality in patients with acute myocardial infarction in the real world? A nationwide patient cohort study

“…The various patterns of the imbalance in the baseline characteristics between the IHT group and non-IHT group among previous studies were also noticeable. Some studies reported that patients transferred with AMI were younger and had fewer comorbidities than those treated solely at the presenting hospital [ 19 , 20 ]; other studies had similar baseline characteristics [ 7 , 8 ]. In other studies, however, the transferred patients had a more pre-hospital cardiac arrest, a higher rate of cardiovascular risk factors, and Killip classes 3 or 4 on presentation [ 5 , 6 ].…”

Barriers and facilitators to interhospital transfer of acute pulmonary embolism: An inductive qualitative analysis

“…Transferring patients between institutions, to facilitate advanced care may be necessary to achieve optimal clinical outcomes and salvage of life, but it also represents a period of heightened vulnerability for patients as well as physicians responsible for their care. IHT has been extensively studied, for numerous acute medical conditions such as trauma, acute ST-elevation myocardial infarction and stroke (14)(15)(16). However, the process of IHT for PE is less well understood.…”