Abstract 13066: The Association of Transfer-out Rates from Hospitals Without Revascularization Capabilities and Long-term Mortality Risk Among Older Nstemi Patients
Background: Patients with NSTEMI who present initially to hospitals lacking revascularization capabilities are often transferred to other hospitals for early invasive management, but older patients are less likely to be treated invasively and may be less likely to be transferred
Methods: We identified 5,678 older NSTEMI patients who presented to 65 revascularization-incapable hospitals in the US that participated in the CRUSADE registry from 2003 to 2006 and had linked longitudinal Medicare claims data. Hospitals were categorized into 2 groups based upon the observed variation of hospital-level transfer-out rates (low: 40% of patients transferred). Cox proportional hazard models were used to compare the association between transfer-out rates and 3-year mortality between hospital groups.
Results: Transfer out rates varied from 4-92% with 27 hospitals transferring out 40% of their patients. Compared with patients (n = 2,715) from low transfer-out hospitals, those from high transfer-out hospitals (n = 2,963) were younger; had fewer co-morbidities, and were more likely to receive evidence-based acute medications. Patients from high transfer-out hospitals had lower unadjusted mortality rates through 3 years (46% vs. 52%, HR = 0.83, 95%CI: 0.73-0.96 - see figure) but the adjusted risk of 3-year mortality was similar (adjusted HR = 0.99, 95% CI: 0.89-1.09).
Conclusions: Transfer rates for older NSTEMI patients vary significantly among hospitals without revascularization capabilities. Hospitals with higher transfer-out rates tend to care for patients with a lower burden of co-morbidities who are more likely to receive acute evidence-based medications for NSTEMI. These differences in hospital-level case mix may explain the lack of difference in the adjusted long-term mortality risk between hospital categories.
- © 2013 by American Heart Association, Inc.