Heart connected to hospitals, symbolizing patient transfer for heart failure care.

Heart Failure Care: How Early Transfers Can Impact Recovery

Lena Kashyap in Health & Wellness December 2025 • 4 min read.

"Discover how Japanese hospitals are using early patient transfers to improve outcomes and manage resources in heart failure treatment."

Heart failure (HF) is a major health challenge worldwide, leading to frequent hospitalizations, increased morbidity and mortality, and significant strain on healthcare systems. In Japan, the situation is becoming critical with a predicted rise in the number of HF patients to 1.3 million by 2030, creating what experts term an 'HF pandemic.' This surge is causing bed shortages in core hospitals that are equipped to handle acute HF cases.

To address these challenges, a new approach is being explored: regional cooperation between core hospitals and collaborating hospitals. Core hospitals begin the acute treatment, and once patients are stabilized, they are transferred to collaborating hospitals for ongoing care. However, questions remain about the safety and effectiveness of transferring patients during the early treatment phase.

A recent study investigated the outcomes of early HF patient transfers from a core hospital to collaborating hospitals in Japan. The study aimed to determine if this approach, when combined with well-defined treatment strategies, could maintain or improve patient prognoses.

The Impact of Early Transfer Strategies on Patient Outcomes

Heart connected to hospitals, symbolizing patient transfer for heart failure care.

The study, published in the International Heart Journal in 2018, focused on 166 patients hospitalized with acute HF between January 1, 2015, and December 31, 2015. Researchers compared two groups: patients transferred early to collaborating hospitals (n = 53, median transfer time of 6 days) and those who remained in the core hospital (n = 113).

The primary goal was to assess whether early transfer affected one-year mortality rates and the combined rate of mortality and HF readmission. The findings challenged some common assumptions about patient transfers.

Similar Mortality Rates: The one-year mortality rates were similar between the transferred (24.5%) and non-transferred groups (19.5%).
No Increased Risk: Multivariate analysis showed that patient transfers were not associated with a higher risk of the composite endpoint (mortality and HF readmission).
Importance of Congestion Management: Patients with low composite congestion scores (CCSs) at the time of transfer had significantly better outcomes.

These results indicate that early transfer, when managed with careful treatment strategies, does not negatively impact patient outcomes. This approach could help alleviate the strain on core hospitals, freeing up beds for new acute cases.

Strategic Decongestion is Key

The study underscores the importance of strategic decongestion before transferring patients. By ensuring patients are stable and have low congestion scores, hospitals can optimize the benefits of early transfer. This approach not only aids in resource management but also maintains quality of care. Further studies are needed to explore how these strategies can be adapted and implemented in different healthcare systems worldwide to combat the growing heart failure pandemic.

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This article is based on research published under:

DOI-LINK: 10.1536/ihj.17-449, Alternate LINK

Title: Early Transfer Of Patients With Acute Heart Failure From A Core Hospital To Collaborating Hospitals And Their Prognoses

Subject: Cardiology and Cardiovascular Medicine

Journal: International Heart Journal

Publisher: International Heart Journal (Japanese Heart Journal)

Authors: Tetsuo Yamaguchi, Takamichi Miyamoto, Masahiro Sekigawa, Keita Watanabe, Sadahiro Hijikata, Junji Yamaguchi, Takamasa Iwai, Yuichiro Sagawa, Ryoichi Miyazaki, Ryo Masuda, Naoyuki Miwa, Nobuhiro Hara, Yasutoshi Nagata, Toru Obayashi, Toshihiro Nozato

Published: 2018-09-01

Everything You Need To Know

What is the major health concern that is discussed?

Heart failure (HF) is a widespread health issue characterized by frequent hospitalizations, increased morbidity and mortality, and a heavy burden on healthcare systems. The situation is intensifying in Japan, with a projected rise in HF patients to 1.3 million by 2030, termed an 'HF pandemic' by experts. This surge is leading to bed shortages in core hospitals, which are essential for managing acute HF cases.

What is meant by 'early transfer' in the context of heart failure treatment?

Early transfer refers to the practice of moving acute heart failure patients from core hospitals, where initial treatment is provided, to collaborating hospitals for ongoing care after stabilization. This approach is being explored to address the growing challenges of managing HF patients and optimizing healthcare resources in Japan, where the number of HF patients is increasing.

What were the key findings of the study on early transfers?

The study published in the *International Heart Journal* in 2018, compared two groups: those transferred early to collaborating hospitals and those who remained in the core hospital. The primary goal was to assess if early transfer affected one-year mortality rates and the combined rate of mortality and HF readmission. The study found that one-year mortality rates were similar between the transferred and non-transferred groups. Also, patient transfers were not associated with a higher risk of the composite endpoint (mortality and HF readmission).

Why is strategic decongestion important in this approach?

Strategic decongestion involves stabilizing patients and ensuring they have low congestion scores before transferring them to collaborating hospitals. The findings of the study suggest that patients with low composite congestion scores (CCSs) at the time of transfer had significantly better outcomes. This approach is key for optimizing the benefits of early transfer and maintaining quality of care while addressing the strain on core hospitals.

What are the implications of these findings for heart failure treatment?

The study's findings suggest that early transfer, when combined with well-defined treatment strategies, does not negatively impact patient outcomes and is a viable approach to manage the increasing number of heart failure patients. Further studies are needed to explore how these strategies can be adapted and implemented in different healthcare systems worldwide to combat the growing heart failure pandemic. This can involve exploring the implementation of regional cooperation between core hospitals and collaborating hospitals, improving resource management, and maintaining quality of care.