Impact of transfer from non-acute care centers on clinical outcomes in patients with congestive heart failure

Abstract

Study objectiveTo compare the clinical outcomes in patients with congestive heart failure who are transferred to an acute care hospital from non-acute care centers with patients who are admitted as regular hospital admissions. DesignThis was a retrospective cohort study. SettingWe utilized the National Inpatient Sample database from 2016 to 2018. ParticipantsOur cohort consisted of hospitalized patients who were at least 18 years old with a primary diagnosis of congestive heart failure. InterventionsThese patients were either transferred from non-acute centers or presented as regular hospital admissions. Main outcome measurementsWe matched patients in a greedy nearest neighbor 1:1 model with caliper set at 0.2. Multivariable logistic regression, adjusted for age, sex, race and comorbidities, was used to compare mortality in our matched cohort. ResultsThis study included 35,010 non-acute care transfers and 951,189 regularly admitted patients. Compared to patients who were not transferred, non-acute care transfers were older, predominantly female, White and less racially diverse. After matching, there were 6689 patients in each cohort. When adjusted for age, race, sex and comorbidities, non-acute care transfers with congestive heart failure had 2.20 times higher odds of suffering in-hospital mortality compared to regular, non-transferred admissions (aOR 2.20, 95 % CI: 1.85–2.61; p < 0.001). ConclusionOur findings illustrate that non-acute care transfers are a vulnerable population that require additional medical support in the acute care setting.