Inter-hospital transfers in acute myocardial infarction and cardiogenic shock
Nona P, Dhillon D, Mawri S, Cowger J, Alaswad K, Khandelwal AK, O'Neill WW, and Basir MB. Inter-hospital transfers in acute myocardial infarction and cardiogenic shock. Catheterization and Cardiovascular Interventions 2020; 95:S180.
Catheterization and cardiovascular interventions
Background: Limited data exist on the use of “hub and spoke” models to transfer patients who present in cardiogenic shock. We sought to assess outcomes of patients transferred to our shock center within our network to those who presents from institutions out of our network.
Methods: From January 2014 to June 2017, 110 patients transferred to our shock center with an admission diagnosis of acute myocardial infarction and cardiogenic shock (AMICS) based on ICD coding. Demographics, admission, procedural and clinical outcomes were obtained for all patients and compared. Statistical analysis was performed using two-sample t-tests, Wilcoxon rank sum tests, chi-square tests and Fisher exact tests.
Results: 35 patients were transferred within our network and 75 patients presented out of our network. The average age of the cohort was 66.4 years. In-network patients were less likely to present with in-hospital cardiac arrest (12.1% vs. 35.7%, p=0.013). In-network patients presented with lower cardiac output (CO) (3.2 L/m ± 0.7 vs 4.5 L/m ± 1.0; p=0.019) but were less likely to be on vasopressors (42.3% vs 72.2%, p=0.018) upon transfer. Similarly, in-network patients had a lower cardiac output following initiation of mechanical circulatory support (3.9 L/m ± 0.9 vs. 5.7 L/m ± 2.3, p=0.010), but higher SBP after initiation of MCS (124.7 mmHg ± 28.2 vs. 105.5 mmHg ± 25.2, p=0.006). Overall, in-network patients had shorter delays from AMI onset to MCS when compared to out of network patients. In-network patients had improved survival to hospital discharge (62.9% vs 41.3%, p=0.035).
Conclusions: Patients who presented to our shock center from an innetwork hospital had improved survival to hospital discharge when compared to patients who presented from outside our network. Further system based processes are needed to best optimize care of patients transferred with acute myocardial and cardiogenic shock.