Abstract 14181: Interhospital Transfer for Heart Failure in the United States: A Patient and Hospital-Level Analysis From GWTG-HF

Abstract

Background: Cardiovascular diseases, particularly heart failure (HF), are common reasons for interhospital transfer (IHT) in the United States. IHT targets patients requiring a higher level of care, and has been associated with increased cost, length of stay (LOS), and mortality. We aim to describe the characteristics and outcomes of patients undergoing IHT, as well as variation in the use of IHT across hospitals. Methods: Patients hospitalized for HF who were admitted from another hospital were compared to those who were not within the Get With The Guidelines-Heart Failure registry between January 2015 and June 2022. Hospital characteristics were obtained from the 2018 American Hospital Association Survey. Clinical data from the receiving hospital were analyzed. Results: Overall, 662,575 patients across 622 hospitals (156,263 patients at 127 transplant centers; 19,852 patients at 55 rural sites) were included, of which 36,375 (5.5%) arrived as IHT. IHT patients were younger (70.0 vs 73.0 years), more male (58 vs 52%), white (72 vs 66%), and more often had private insurance (31% vs 27%). IHT patients had a lower median left ventricular ejection fraction (37 vs 45%), median blood pressure (130/74 vs 139/77 mmHg), and a longer mean LOS (6.3 vs 5.0 days). In a multivariable model, IHT patients had higher in-hospital mortality (OR 1.85, 95% CI 1.76-1.95), were less likely to discharge home (OR 0.79, 95% CI 0.77-0.81), and were more likely to be prescribed most guideline-directed therapies (Figure). Conclusions: More than 1 in 20 patients hospitalized for HF was transferred from another hospital. Sex, racial, economic, and geographic differences exist in which HF patients get transferred, and rates of IHT varied across hospitals. IHT was associated with higher mortality and longer LOS compared with non-transferred patients.