Impact of transfer from non-acute care centers on clinical outcomes in patients with congestive heart failure

Abstract

Study objective: To compare the clinical outcomes in patients with congestive heart failure who are transferred to an acute care hospital from non-acute care centers with patients who are admitted as regular hospital admissions. Design: This was a retrospective cohort study. Setting: We utilized the National Inpatient Sample database from 2016 to 2018. Participants: Our cohort consisted of hospitalized patients who were at least 18 years old with a primary diagnosis of congestive heart failure. Interventions: These patients were either transferred from non-acute centers or presented as regular hospital admissions. Main outcome measurements: We matched patients in a greedy nearest neighbor 1:1 model with caliper set at 0.2. Multivariable logistic regression, adjusted for age, sex, race and comorbidities, was used to compare mortality in our matched cohort. Results: This study included 35,010 non-acute care transfers and 951,189 regularly admitted patients. Compared to patients who were not transferred, non-acute care transfers were older, predominantly female, White and less racially diverse. After matching, there were 6689 patients in each cohort. When adjusted for age, race, sex and comorbidities, non-acute care transfers with congestive heart failure had 2.20 times higher odds of suffering in-hospital mortality compared to regular, non-transferred admissions (aOR 2.20, 95 % CI: 1.85–2.61; p < 0.001). Conclusion: Our findings illustrate that non-acute care transfers are a vulnerable population that require additional medical support in the acute care setting.

Keywords

• Congestive heart failure
• Non-acute care
• Transfers
• Nursing homes
• Urgent care centers