Abstract 17072: Mortality Outcomes Following Inter-Hospital Transfer (IHT) for Acute Myocardial Infarction (AMI)

Background: IHT is common in AMI yet there are limited population studies evaluating its effect upon mortality. Methods: All patients (n=40,028) with a principle ICD10 diagnosis of AMI (14,115 STEMI, 25,913 NSTEMI) admitted to 161 acute care hospitals in New South Wales, Australia from 2004-08, with linkage to the state death register for post-discharge mortality. The effect of IHT upon mortality was compared using a 1:1 propensity score matched (PSM) sample with matching based on 74 variables encompassing patient demographic characteristics, background history, acute complications at presentation and presenting hospital characteristics. Median follow-up was 3.5 years (range 1.5-5.5). Results: 29,939 (74.8%) patients received care at the presenting hospital while 10,089 (25.2%) were transferred. Transferred patients were younger, had less pre-existing cardiac disease, fewer comorbidities and less acute complications at presentation. They were more likely to have an initial admission at a regional (33.3%vs21.2%, p Conclusion: IHT is associated with a survival advantage which is present within 30 days following AMI and sustained long-term. Greater use of revascularisation by IHT only partially explains the observed survival gains of IHT.