Association of transfer time and delays with outcomes for patients with acute pulmonary embolism requiring interhospital transfer: a retrospective observational study

Abstract

Background: Interhospital transfer (IHT) for pulmonary embolism (PE) is increasingly performed to improve access to advanced reperfusion therapies, but it is unclear if IHT times influence overall outcomes. We studied the association between transfer times and outcomes of patients with acute PE requiring IHT.

Methods: 139 patients with acute PE undergoing IHT to the Mount Sinai Health System between September 2021 and June 2023 were retrospectively studied. Primary outcomes were 30-day mortality and 30-day major bleeding. 'Door to IHT' time was defined as the time from diagnosis of acute PE to the time patient physically arrived in the receiving hospital. Patients were divided into groups based on quartiles of 'door to IHT' time; those within the first and fourth quartiles of 'door to IHT' time were compared using propensity score-weighted analyses. The propensity score was calculated from six variables: age, sex, BMI [Body Mass Index], PESI [PE Severity Index] score, ESC [European Society of Cardiology] risk class and presence of a central PE. Multivariable regression models were fitted within the propensity score-matched sample to assess the association of 'door to IHT' time with primary outcomes.

Results: Median age of included patients was 61 years and 76 (54.7%) were women. Median PESI score was 88 points. Median 'door to IHT' time was 10.8 (IQR: 7.3-19.4) hours. Rates of 30-day mortality and 30-day major bleeding were 7.2% and 2.2%. Within propensity score-weighted analyses, no significant associations were found between 'door to IHT' time and any of the primary outcomes (30-day mortality or 30-day major bleeding).

Conclusion: In this retrospective study of patients with acute PE undergoing IHT, differences in 'door to IHT' time were not significantly associated with 30-day mortality or 30-day major bleeding. This suggests that delays in IHT do not adversely influence outcomes of patients with acute PE undergoing IHT.

Keywords: Pulmonary embolism; embolectomy; mortality; patient transfer; venous thromboembolism.

Figure 1.

A flowchart depicting the inclusion and exclusion of eligible patients in the final analysis. IHT=interhospital transfer; PE=pulmonary embolism; PERT = PE response team.