Impact of Advanced Therapy Centers on Characteristics and Outcomes of Heart Failure Admissions

Background Although much attention has been paid to admission and transfer patterns for cardiogenic shock, contemporary data is lacking on decompensated heart failure (HF) admissions and transfers, and the impact of advanced therapy centers (ATCs) on outcomes. Methods HF hospitalizations were obtained from the Nationwide Readmissions Database 2016-2019. Centers performing at least one heart transplant or left ventricular assist device were classified as ATCs. Patient characteristics, outcomes, and procedural volume were compared among three cohorts: admissions to non-ATCs, admissions to ATCs, transfers to ATCs. A secondary analysis evaluated outcomes for severe HF hospitalizations (cardiogenic shock, cardiac arrest, mechanical ventilation). Results 2,331,690 hospitalizations were admissions to non-ATCs (94.5% of centers), 525,037 were admissions to ATCs (5.5% of centers), and 15,541 were transfers to ATCs. Patients treated at ATCs (especially those transferred) had higher rates of HF decompensations, procedural frequency, lengths-of-stay, and costs. Unadjusted mortality was 2.6% at non-ATCs and was higher at ATCs, both for directly admitted (2.9%, p<0.01) and transferred (11.2%, p<0.01) patients. However, multivariable adjusted mortality was significantly lower at ATCs, both for directly admitted (OR 0.82, p<0.01) and transferred (OR 0.66, p<0.01) patients. For severe HF admissions, unadjusted mortality was 37.2% at non-ATCs and was lower at ATCs, both for directly admitted (25.3%, p<0.01) and transferred (25.2%, p<0.01) patients, with similarly lower multivariable adjusted mortality. Conclusions HF patients treated at ATCs were sicker but associated with higher procedural volume and lower adjusted mortality. Clinical Perspective Contemporary data is lacking on admissions and transfers for decompensated heart failure (HF) and the impact of advanced therapy centers (ATCs) on outcomes. Our findings show that decompensated HF patients treated at ATCs had higher rates of HF decompensations, procedural frequency, lengths-of-stay, and costs. While unadjusted mortality was higher at ATCs, multivariable adjusted mortality was significantly lower at ATCs, both for directly admitted and transferred patients. Our findings will hopefully prompt earlier recognition and referral of patients to ATCs, emphasize the need for increased numbers of ATCs, and spark further research into the decision-making process for referral to ATCs.