The Association of Transfer Rate From Hospitals Without Revascularization Capabilities and Mortality Risk for Older Non-ST-Segment Elevation Myocardial Infarction Patients.
BACKGROUND
Interhospital transfer invasive management patterns and implications for older non-ST-segment elevation myocardial infarction (NSTEMI) patients initially presenting to non-revascularization-capable hospitals have not been explored.


OBJECTIVE
Patients admitted to hospitals with a higher transfer proportion have lower risk of long-term mortality.


METHODS
We linked CRUSADE Registry data on 5678 patients age ≥65 years from 65 United States non-revascularization-capable hospitals (2003-2006) with inpatient Medicare longitudinal claims. Hospitals were categorized according to hospital-level patient transfer-out rates, low (≤40%) vs high (>40%). The associations between transfer-out rates and 30-day, 6-month, and 3-year mortality risk were evaluated using Cox proportional hazard models.


RESULTS
Hospital-level transfer-out rates varied widely (median, 43%; interquartile range, 31%-54%). Compared with patients from low-transfer-out hospitals (n = 2715), patients from high-transfer-out hospitals (n = 2963) were more likely to be male, less likely to have renal insufficiency and prior heart failure, and had lower long-term CRUSADE mortality risk scores. These patients also more commonly received evidence-based acute medications before transfer and underwent subsequent revascularization after transfer. The adjusted risks of mortality at various time intervals were similar for those from high- vs low-transfer-out hospitals: 30 days (hazard ratio: 0.95, 95% confidence interval: 0.79-1.14), 6 months (0.97, 0.84-1.12), and 3 years (1.01, 0.91-1.11).


CONCLUSIONS
Transfer rates for older NSTEMI patients vary widely among non-revascularization-capable hospitals. Despite lower predicted mortality risk and higher rates of post-transfer revascularization, patients from high-transfer-out hospitals had a similar risk for short- and long-term mortality compared with those from low-transfer-out hospitals.
Department of Cardiology, Shanghai Renji Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China.
Lan
L
Shen
Department of Medicine, Duke Clinical Research Institute, Durham, North Carolina.
Bimal R
BR
Shah
Department of Biostatistics & Bioinformatics, Duke Clinical Research Institute, Durham, North Carolina.
Shuang
S
Li
Department of Biostatistics & Bioinformatics, Duke Clinical Research Institute, Durham, North Carolina.
Laine
L
Thomas
Department of Medicine, Duke Clinical Research Institute, Durham, North Carolina.
Tracy Y
TY
Wang
Department of Medicine, Duke Clinical Research Institute, Durham, North Carolina.
Karen P
KP
Alexander
Department of Medicine, Duke Clinical Research Institute, Durham, North Carolina.
Eric D
ED
Peterson
Department of Cardiology, Shanghai Renji Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China.
Ben
B
He
Department of Medicine, Duke Clinical Research Institute, Durham, North Carolina.
Matthew T
MT
Roe
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012042:Registries; D014481:United States