Interhospital Transfer for Heart Failure in the United States: A Patient and Hospital-Level Analysis from Get With The Guidelines-Heart Failure.

BACKGROUND: Heart failure (HF) is a complex clinical condition that often requires interhospital transfer (IHT) to ensure that patients have access to the level of expertise and care that they require. However, little is known about IHT in the HF population. Therefore, we aimed 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 transferred in from another hospital were compared with those who were not transferred in using data from 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 were included, of which 36,375 (5.5%) arrived as IHT (median [interquartile range] proportion of IHT by hospital, 1.9% [0.17%-5.88%]). Compared with patients who were not transferred in, IHT patients were younger (median age, 70 vs 73 years) and more likely to be male (58.1% vs 52.3%), White (72.0% vs 66.2%), and have private insurance (31.2% vs 26.8%). IHT patients had lower left ventricular ejection fractions (54.1% vs 41.9% with an LVEF ≤40%), lower median blood pressure (130/74 vs 139/77 mm Hg), and a longer median length of stay (5.0 vs 4.0 days). In a multivariable regression model adjusting for variables available at time of transfer, IHT patients had higher in-hospital mortality (odds ratio [OR], 1.85; 95% confidence interval [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 guideline-directed therapies at hospital discharge. CONCLUSIONS: More than 1 in 20 patients hospitalized for HF at hospitals participating in the Get With The Guidelines-Heart Failure program were transferred from another hospital. Rates of IHT varied across hospitals; there were sex, racial, economic, and geographic differences. Compared with patients who were not transferred in, patients with IHT had higher mortality and longer length of stay. Further efforts to assess IHT use, care quality, and outcomes are warranted to optimize transfer decisions and to contextualize hospital outcomes measures.

Duke Scholars

Author Karen Chiswell  

Author Stephen Greene Medicine, Cardiology

Author Iyanuoluwa Ayodele