NATIONAL INTER-HOSPITAL TRANSFER PRACTICES FOR PATIENTS WITH ACUTE CARDIOVASCULAR CONDITIONS

Abstract

Little is known about inter-hospital transfer practices for patients with acute cardiovascular conditions in Canada. Although ST-elevation myocardial infarction systems of care are protocolized in most regions, care processes for other conditions often do not exist. Thus, we described patient characteristics and outcomes of transferred patients with acute cardiovascular disease in Canadian hospitals. We reviewed the Canadian Institute for Health Information (CIHI) Discharge Abstract Database for patients age ≥ 18 years hospitalized with a primary admission diagnosis of acute cardiovascular disease (International Classification of Diseases-10 category “I”) between 2013 and 2018 in all Canadian provinces except Québec. We compared patient characteristics and clinical outcomes based on transfer status (transferred vs. non-transferred) and presenting hospital (teaching hospitals vs. large, medium, and small community hospitals). There were 476,753 patients with acute cardiovascular diagnoses, among whom 48,579 (10.1%) were transferred. Large community hospitals most frequently transferred (n=16,038, 33.0%) and teaching hospitals more frequently received (n=28,653, 59.0%) patients (Figure). Transferred patients were more frequently younger (median age 67 [IQR 18] vs. 74 [IQR 21], p < 0.001), male (69.9% vs. 57.9%, p < 0.001), and had fewer cardiovascular comorbidities (Table). The most common primary diagnoses among transferred patients were non-ST-elevation myocardial infarction (44.2%), ST-elevation myocardial infarction (29.0%), and congestive heart failure (9.4%). Using teaching hospitals as a reference, hospital mortality was lowest among patients transferred to large and medium community hospitals (adjusted OR 0.83, 0.75-0.91 and 0.45, 0.39-0.52, respectively), after adjusting for age, sex, comorbidities, and care location. Hospital mortality was higher for patients transferred to small community hospitals (adjusted OR 1.93, CI 1.64-2.28). Approximately 10% of patients presenting with acute cardiovascular conditions are transferred to other hospitals. Patient transfer is associated with lower in-hospital mortality, although there is variability in outcomes depending on diagnosis, comorbidities, hospital of origin, and destination hospital. Further investigation of transfer practices for acute cardiovascular disease is warranted as regionalized care models continue to develop in Canada.View Large Image Figure ViewerDownload Hi-res image Download (PPT)