(P050) CAN IMPROVING THE EFFECTIVENESS OF INTERHOSPITAL TRANSFER WITHIN BRITISH COLUMBIA AND THE YUKON TERRITORY FOR CARDIAC PATIENTS HELP NARROW HEALTH DISPARITIES?

Background: Cardiovascular disease is the leading cause of death among Canadians and access to timely treatment is known to impact outcomes. Due to the geographical vastness of Canada, many Canadians living in rural and small communities require interfacility transfer for emergent care in a timely manner. Delays in treatment results in unnecessary suffering and worse outcomes. Our quality improvement study aims to examine transfer times between healthcare centers across British Columbia(BC) and the Yukon Territories(Northwestern Canada) for acute cardiac conditions, to determine the efficacy and safety of interhospital transfers from rural communities.

METHODS AND RESULTS: Following institutional approval, a retrospective analysis of consecutive patients transferred to St. Paul’s Hospital in Vancouver, from a healthcare center in Northwestern Canada between April 2022 and February 2024 was undertaken. Interfacility transfers were coordinated using a provincial publicly-funded transport system using all available transport modalities. The priority status for transfers was in accordance with provincial guidelines with the “Life, Limb or Threatened Organ” (LLTO) for immediate transfer. Demographic and clinical data were extracted from medical records. Rurality was determined by the BC Rural Subsidiary Agreement community designation system. A designation of ‘D’ represents urban communities. Communities with an A/B/C designation were classified as rural, with ‘A’ considered the most rural.

Our total cohort of n = 908, composed primarily of males(73.8%). The primary diagnosis for transfer was an acute coronary syndrome ACS(63%), with a predominance for ST segment- elevation(STE) vs. Non-STE at a ratio of 2:1. Other major categories for transfer include congestive cardiac failure(11%), vent arrhythmia(7%), brady arrhythmia(7%) and cardiogenic shock(4%). Rural community patients (category A+B+C) had a more prevalent history of prior myocardial infarction, higher rates of cigarette smoking , and COPD than urban(category D) patients (p < 0.023 for all).

Rural community patients had a higher median transfer time and distance than the general population, while “LLTO” patients had significantly shorter transfer times (Figure 1 and 2)

Post initiation of transfer, death occurred in n = 9(1%) of patients before arrival.

Conclusion: The most prevalent diagnosis for interfacility transfer was ACS. Patients from rural communities had a significantly longer time and distance of transfer. The LLTO patients had significantly shorter transfer times. Very few(1%) died before completion of transfer. Our data supports the presence a safe interhospital transfer system. However, further work is needed to lower transfer times from rural communities to prevent further widening of health care disparities in rural and marginalized populations.