European journal of heart failure | 2021
Impact of Hospital Transfer to Hubs on Outcomes of Cardiogenic Shock in Real World.
Abstract
AIMS\nCardiogenic shock (CS) is associated with significant mortality, and there is a movement towards regional hub-and-spoke triage systems to coordinate care and resources. Limited data exist on outcomes of patients treated at CS transfer hubs.\n\n\nMETHODS AND RESULTS\nCS hospitalizations were obtained from the Nationwide Readmissions Database 2010-2014. Centers receiving any interhospital transfers with CS in a given year were classified as CS transfer hubs ; those without transfers were classified as spokes. In-hospital mortality was compared among 3 cohorts: (A) direct admissions to spokes, (B) direct admissions to hubs, and (C) interhospital transfer to hubs. Among hospitals treating CS, 70.6% were classified as spokes and 29.4% as hubs. 130,656 (31.7%) hospitalizations with CS were direct admission to spokes, 253,234 (61.4%) were direct admissions to hubs, and 28,777 (7.0%) were transfer to hubs. CS mortality was 47.8% at spoke hospitals and was lower at hub hospitals, both for directly admitted (39.3%, p<0.01) and transferred (33.4%, p<0.01) patients. Hospitalizations at hubs had higher procedural frequency (including coronary artery bypass graft, right heart catheterization, mechanical circulatory support), greater length of stay, and greater costs. On multivariable analysis, direct admission to CS hubs (OR 0.86, CI 0.84-0.89, p<0.01) and transfer to hubs (OR 0.72, CI 0.69-0.76, p<0.01) were both associated with lower mortality.\n\n\nCONCLUSION\nWhile acknowledging the limited ability of the NRD to classify CS severity on presentation, treatment of CS at transfer hubs was associated with significantly lower mortality within this large real-world sample.