Short-term outcomes of patients transferred from non-acute care centers with sick sinus syndrome
Authors: Gill A , Al-Taweel O , Fakhra S , Tun K M , Hawwass D , Ahsan C 
Published: October 2022

Abstract

Background
Non-acute care centers, such as nursing homes and urgent care clinics, are a staple of healthcare systems worldwide. The short-term prognostic outcomes of patients transferred from a non-acute care center to an acute healthcare facility for further management have been less studied.

Purpose
In this study, we examine the in-hospital outcomes of patients with sick sinus syndrome who are transferred to an acute care hospital from a non-acute care center.

Methods
This was a retrospective cohort study comparing adult patients who were transferred to a hospital from a non-acute center with regular, non-transferred hospital admissions between 2016 to 2018. We queried the National Inpatient Sample database to identify patients admitted with a principal diagnosis of sick sinus syndrome. We analyzed the categorical and continuous variables by Pearson's chi-squared and Student t-test respectively. Multivariable logistic regression, adjusted for age, gender and comorbidities was used to compare mortality. The comorbidities adjusted for included atrial fibrillation, atrial flutter, first and third-degree atrioventricular block, heart failure, hypertension, obstructive sleep apnea and type 2 diabetes mellitus.

Results
120,300 patients met our inclusion criteria. Patients transferred from non-acute care centers had 2.63 times higher odds of suffering in-hospital mortality compared to regular hospital admissions (aOR 2.63, 95% CI: 1.54–4.49; p&lt;0.001). When separated by race, non-acute care transfers had higher mortality rates amongst Asian (6.9% vs 0.7%, p&lt;0.001), Hispanic (4.8% vs 0.8%, p&lt;0.001) and White (1.8% vs 0.6%, p&lt;0.001, Figure 1) patients as well as longer hospital stays (4.7 vs 4.0 days, p&lt;0.001, Table 1). Furthermore, these patients had higher rates of comorbidities such as atrial fibrillation, atrial flutter, heart failure and chronic kidney disease, but decreased rates of hypertension, type 2 diabetes mellitus and first and third-degree atrioventricular block (Table 1). Non-acute care transfers were also more likely to have a pacemaker placed (1.5% vs 0.9%, p&lt;0.001). In terms of operative complications, non-acute transfers were more likely to have intraoperative cardiac arrest (0.1% vs 0.03%, p&lt;0.005, Table 1). There was no significant difference between our two cohorts in postoperative complications such as cardiac arrest and intracerebral infarction.

Conclusion
Patients who were transferred to an acute care hospital from a non-acute care center with sick sinus syndrome had higher odds of suffering in-hospital mortality compared to regular hospital admissions. These patients were also at increased risk of intraoperative cardiac arrest. Our findings illustrate that non-acute care transfers require additional support in the acute care setting. This study highlights the need for further health policy discussion and an increased emphasis on medical resource reallocation to support this vulnerable population.

Funding Acknowledgement
Type of funding sources: None.