Inter-hospital transfer in patients with acute myocardial infarction in China: Findings from the improving care for cardiovascular disease in China-acute coronary syndrome project

Danqing Hu; Yongchen Hao; Jun Liu; Na Yang; Yiqian Yang; Zhaoqing Sun; Dong Zhao; Jing Liu

doi:10.3389/fcvm.2022.1064690

Inter-hospital transfer in patients with acute myocardial infarction in China: Findings from the improving care for cardiovascular disease in China-acute coronary syndrome project

Front Cardiovasc Med. 2022 Dec 8:9:1064690. doi: 10.3389/fcvm.2022.1064690. eCollection 2022.

Authors

Danqing Hu¹, Yongchen Hao¹, Jun Liu¹, Na Yang¹, Yiqian Yang¹, Zhaoqing Sun¹, Dong Zhao¹, Jing Liu¹

Affiliation

¹ Department of Epidemiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China.

Abstract

Background: Little is known about the current scenario of inter-hospital transfer for patients with acute myocardial infarction (AMI) in China.

Methods: From November 2014 to December 2019, 94,623 AMI patients were enrolled from 241 hospitals in 30 provinces in China. We analyzed the pattern of inter-hospital transfer, and compared in-hospital treatments and outcomes between transferred patients and directly admitted patients.

Results: Of these patients, 40,970 (43.3%) were transferred from hospitals that did not provide percutaneous coronary intervention (PCI). The proportion of patients who were transferred from non-PCI hospital was 46.3% and 11.9% (P < 0.001) in tertiary hospitals and secondary hospitals, respectively; 56.2% and 37.3% (P < 0.001) in hospitals locating in low-economic regions and affluent areas, respectively. Compared with directly admitted patients, transferred patients had lower rates of reperfusion for STEMI (57.8% vs. 65.2%, P < 0.001) and timely PCI for NSTEMI (34.7%vs. 41.1%, P < 0.001). The delay for STEMI patients were long, with 6.5h vs. 4.5h from symptom onset to PCI for transferred and directly admitted patients, respectively. The median time-point was 9 days for in-hospital outcomes. Compared with direct admission, the hazard ratios and 95% confidence intervals associated with inter-hospital transfer were 0.87 (0.75-1.01) and 0.87 (0.73-1.03) for major adverse cardiovascular events and total mortality, respectively, in inverse probability of treatment weighting models in patients with STEMI, and 1.02 (0.71-1.48) and 0.98 (0.70-1.35), respectively, in patients with NSTEMI.

Conclusion: More than 40% of the hospitalized AMI patients were transferred from non-PCI-capable hospitals in China. Further strategies are needed to enhance the capability of revascularization and reduce the inequality in management of AMI.

Keywords: acute myocardial infarction; direct admission; early revascularization; in-hospital outcomes; inter-hospital transfer.