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Patterns of transfer for patients with non-ST-segment elevation acute coronary syndrome from community to tertiary care hospitals.
Am Heart J. 2008 Jul; 156(1):185-92.AH

Abstract

BACKGROUND

Practice guidelines for non-ST-segment elevation acute coronary syndromes (NSTE ACS) recommend early invasive management (cardiac catheterization and revascularization within 48 hours of hospital presentation) for high-risk patients, but interhospital transfer is necessary to provide rapid access to revascularization procedures for patients who present to community hospitals without revascularization capabilities.

METHODS

We analyzed patterns and factors associated with interhospital transfer among 19,238 patients with NSTE ACS (positive cardiac markers and/or ischemic ST-segment changes) from 124 community hospitals without revascularization capabilities in the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines quality improvement initiative from January 2001 through June 2004.

RESULTS

Less than half of the patients (46.3%) admitted to community hospitals were transferred to tertiary hospitals, and fewer (20%) were transferred early (within 48 hours of presentation). Early transfer rates increased by 16% over 10 quarters in patients with a predicted low or moderate risk of inhospital mortality, compared with 5% in high-risk patients. By the last quarter of the analysis, 41.4% of low-risk patients were transferred early versus 12.5% of high-risk patients. Factors significantly associated with early transfer included younger age, lack of prior heart failure, cardiology inpatient care, and ischemic ST-segment electrocardiographic changes. Among patients who were not transferred, 29% had no further risk stratification performed with stress testing, ejection fraction measurement, or diagnostic cardiac catheterization (at hospitals with catheterization laboratories).

CONCLUSIONS

Most patients with NSTE ACS presenting to community hospitals without revascularization capabilities are not rapidly transferred to tertiary hospitals, and lower-risk patients appear to be preferentially transferred early. Further investigation is needed to determine if improved risk-based triage at community hospitals can optimize transfer decision making for high-risk patients with NSTE ACS.

Authors+Show Affiliations

Duke Clinical Research Institute, Durham, NC 27705, USA. roe00001@mc.duke.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18585515

Citation

Roe, Matthew T., et al. "Patterns of Transfer for Patients With non-ST-segment Elevation Acute Coronary Syndrome From Community to Tertiary Care Hospitals." American Heart Journal, vol. 156, no. 1, 2008, pp. 185-92.
Roe MT, Chen AY, Delong ER, et al. Patterns of transfer for patients with non-ST-segment elevation acute coronary syndrome from community to tertiary care hospitals. Am Heart J. 2008;156(1):185-92.
Roe, M. T., Chen, A. Y., Delong, E. R., Boden, W. E., Calvin, J. E., Cairns, C. B., Smith, S. C., Pollack, C. V., Brindis, R. G., Califf, R. M., Gibler, W. B., Ohman, E. M., & Peterson, E. D. (2008). Patterns of transfer for patients with non-ST-segment elevation acute coronary syndrome from community to tertiary care hospitals. American Heart Journal, 156(1), 185-92. https://doi.org/10.1016/j.ahj.2008.01.033
Roe MT, et al. Patterns of Transfer for Patients With non-ST-segment Elevation Acute Coronary Syndrome From Community to Tertiary Care Hospitals. Am Heart J. 2008;156(1):185-92. PubMed PMID: 18585515.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patterns of transfer for patients with non-ST-segment elevation acute coronary syndrome from community to tertiary care hospitals. AU - Roe,Matthew T, AU - Chen,Anita Y, AU - Delong,Elizabeth R, AU - Boden,William E, AU - Calvin,James E,Jr AU - Cairns,Charles B, AU - Smith,Sidney C,Jr AU - Pollack,Charles V,Jr AU - Brindis,Ralph G, AU - Califf,Robert M, AU - Gibler,W Brian, AU - Ohman,E Magnus, AU - Peterson,Eric D, Y1 - 2008/04/14/ PY - 2007/08/13/received PY - 2008/01/31/accepted PY - 2008/7/1/pubmed PY - 2008/8/1/medline PY - 2008/7/1/entrez SP - 185 EP - 92 JF - American heart journal JO - Am Heart J VL - 156 IS - 1 N2 - BACKGROUND: Practice guidelines for non-ST-segment elevation acute coronary syndromes (NSTE ACS) recommend early invasive management (cardiac catheterization and revascularization within 48 hours of hospital presentation) for high-risk patients, but interhospital transfer is necessary to provide rapid access to revascularization procedures for patients who present to community hospitals without revascularization capabilities. METHODS: We analyzed patterns and factors associated with interhospital transfer among 19,238 patients with NSTE ACS (positive cardiac markers and/or ischemic ST-segment changes) from 124 community hospitals without revascularization capabilities in the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines quality improvement initiative from January 2001 through June 2004. RESULTS: Less than half of the patients (46.3%) admitted to community hospitals were transferred to tertiary hospitals, and fewer (20%) were transferred early (within 48 hours of presentation). Early transfer rates increased by 16% over 10 quarters in patients with a predicted low or moderate risk of inhospital mortality, compared with 5% in high-risk patients. By the last quarter of the analysis, 41.4% of low-risk patients were transferred early versus 12.5% of high-risk patients. Factors significantly associated with early transfer included younger age, lack of prior heart failure, cardiology inpatient care, and ischemic ST-segment electrocardiographic changes. Among patients who were not transferred, 29% had no further risk stratification performed with stress testing, ejection fraction measurement, or diagnostic cardiac catheterization (at hospitals with catheterization laboratories). CONCLUSIONS: Most patients with NSTE ACS presenting to community hospitals without revascularization capabilities are not rapidly transferred to tertiary hospitals, and lower-risk patients appear to be preferentially transferred early. Further investigation is needed to determine if improved risk-based triage at community hospitals can optimize transfer decision making for high-risk patients with NSTE ACS. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/18585515/Patterns_of_transfer_for_patients_with_non_ST_segment_elevation_acute_coronary_syndrome_from_community_to_tertiary_care_hospitals_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(08)00138-5 DB - PRIME DP - Unbound Medicine ER -