Our Experience with the "Hub and Spoke" Model in Spain: Results from the First 4 Years

Purpose The “hub and spoke” model provides a network that facilitates the transfer of patients in cardiogenic shock(CS) from community hospitalsto a tertiary care facility for definitive management. Our purpose was to evaluate the results of patients transferred to a “hub” center in Spain in the first 4 years of this program. Methods We retrospectively reviewed all patients transferred to our center with confirmed CS between September 2014 and August 2018. Demographic, clinical and analytical data were collected and subsequently analyzed. The primary outcome was survival at discharge. Results A total of 74 patients in CS from 24 different referring hospitals were initially evaluated for transfer, of which 54 were finally transferred to our center (mean age 50±12 years, 74% men). The main cause of CS was acutely decompensatedHF (41%) followed by acute coronary syndrome (35%). Mechanical circulatory support (MCS) devices were placed in 17 patients (11 VA-ECMO and 6 Centrimag) before transfer and in 21 more upon arrival (70%). Only 6 patients (11%) were managed with no MCS nor IABP. Overall survival to discharge was 63% (n=34), and 18 patients underwent urgent heart transplantation (image 1). CS secondary to acutely decompensatedHF (OR 0.09, CI 0.02-0.51, p=0.006) and referral from a center with cardiac surgery (OR 0.11, CI 0.02-0.60, p=0.01) were independent predictors of survival in this cohort (image 2). Conclusion The “hub and spoke” model achieved an overall survival of 63%, with the most benefit in patients transferred from centers with cardiac surgery and in those with CS secondary to acutely decompensatedHF, in which survival was > 90%.