Impact of inter-hospital transfers and admissions to transfer hubs on outcomes of cardiac implantable electronic device-associated infective endocarditis.

BACKGROUND

Transvenous lead extraction/removal (TLE) is recommended for management of cardiac implantable electronic device (CIED)-associated infective endocarditis (IE). The effect of inter-hospital transfer on management and outcomes of CIED-associated IE has not been studied.

OBJECTIVE

To analyze the impact of inter-hospital transfer on management and outcome of CIED-associated IE.

METHODS

We analyzed 22,682 admissions from the Nationwide Readmissions Database 2016-2019 of patients with CIEDs with a diagnosis of IE. Centers receiving any transfers in a given year for CIED-associated IE were classified as hubs, and others as spokes. Admissions were categorized into direct admissions to spokes, direct admissions to hubs, and transfers to hubs.

RESULTS

Among admissions, 64% were direct to spokes, 22% were direct to hubs, and 15% were transfers to hubs. Transfers were associated with male sex, Staphylococcus aureus infection, and heart failure. TLE rates among direct admissions to spokes, direct admissions to hubs, and transfers to hubs were 4.0%, 12.9%, and 38.1%, respectively (P < .001). Compared with direct admissions to spokes, direct admissions to hubs (adjusted odds ratio [aOR] 3.12, 95% confidence interval [CI] 2.55-3.81) and transfers to hubs (aOR 11.51, 95% CI 9.28-14.25) were independently associated with TLE. After adjustment for age and comorbidities, index and early mortality were similar among direct admissions to spokes, direct admissions to hubs, and transfers to hubs. Among patients who underwent TLE, TLE-associated complications and mortality were similar across groups.

CONCLUSION

Direct admissions to hubs and transfers to hubs are associated with higher utilization of TLE. Mortality and complication rates among patients undergoing TLE at hubs and spokes were comparable.