Acute cardiac care & resuscitationResearch article
Association Between Hospital Tiers and Cardiogenic Shock Mortality: Mitigating the Transfer Penalty Through a Regionalized Hub-and-Spoke Model
- Generalized structural equation modeling analysis of the National Inpatient Sample
- 2016-2022
- 5 hierarchical hospital tiers
- latent Acute Severity construct
Authors' conclusion
Higher hospital cardiac capability is independently associated with lower mortality among patients with cardiogenic shock. Advanced centers are associated with mitigation of transfer-associated risk, supporting regionalized hub-and-spoke systems with early referral to high-capability centers.
Study context
- Population
- Cardiogenic shock hospitalizations in the National Inpatient Sample
- Participants
- 1,177,180 estimated cardiogenic shock hospitalizations
- Comparison
- the relationship between hospital tier and mortality
Main finding
As reported in the abstract
Crude mortality
Further findings
Mortality by hospital tier, adjusted
| Comparison | OR (95% CI) | |
|---|---|---|
| tier 2 · After adjustment | 0.43 (0.38–0.48) | |
| tier 3 · After adjustment | 0.37 (0.32–0.43) | |
| tier 4 · After adjustment | 0.34 (0.30–0.38) | |
| tier 5 · After adjustment | 0.36 (0.31–0.41) | |
| 0.20.5125Odds ratio (log scale) |
Mortality by transfer-in status
| Comparison | OR (95% CI) | |
|---|---|---|
| transfer-in status · associated with increased mortality | 1.36 (1.30–1.43) | |
| 0.512Odds ratio (log scale) |
- Mortality by hospital tier, adjusted: a higher hospital tier was independently associated with lower mortality
Mortality by transfer-in status
- association was attenuated at cardiac surgical and transplant/left ventricular assist device (LVAD) centers
Distribution of hospitalizations
- most occurred at cardiac surgical and transplant/LVAD centers
Original publication
Association Between Hospital Tiers and Cardiogenic Shock Mortality: Mitigating the Transfer Penalty Through a Regionalized Hub-and-Spoke Model. Circ Heart Fail. Published 15 September 2026. doi:10.1161/circheartfailure.126.014546
Summarised from the published abstract; every number is checked against it