National Interhospital Transfer for Patients With Acute Cardiovascular Conditions

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.