Early Follow-Up After a Heart Failure Exacerbation: The Importance of Continuity.
Circ Heart Fail. 2016 Sep;9(9)
Authors: McAlister FA, Youngson E, Kaul P, Ezekowitz JA
Abstract
BACKGROUND: Although early follow-up for heart failure (HF) is recommended, the time window and which physicians should do the follow-up are unclear. We explored whether (1) follow-up within 14 days and (2) physician continuity influence outcomes within 30 days of a HF exacerbation.
METHODS AND RESULTS: Retrospective cohort of all adults in Alberta, Canada, with a first discharge from a hospital or an emergency department where HF was the most responsible diagnosis between April 2002 and November 2013, analyzed using Cox proportional hazards models with time-varying covariates. Of 39 249 adults (mean age,76.1 years), 21 848 (55.7%) received follow-up from a familiar physician, 3938 (10.0%) saw an unfamiliar physician, and 13 463 (34.3%) had no outpatient visits in the first 14 days after a hospitalization or emergency department visit for HF. The risk of death or hospitalization within 30 days was lower in patients who saw a familiar physician (16.9%; adjusted hazard ratio [aHR],0.94;95%confidence interval [CI],0.89-0.99) than inthose who sawan unfamiliar physician (20.0%;aHR,1.05;95%CI,0.97-1.15) or those with no outpatient visits (22.0%;aHR,1.00 [referent]). The composite of death or emergency department visit or hospitalization within 30 days was also less common with familiar physician follow-up (25.2%;aHR,0.86;95%CI,0.82-0.89) compared withunfamiliar physicians (26.9%;aHR,0.93;95%CI,0.87-0.996) or those with no outpatient follow-up within 14 days (47.5%;aHR,1.00 [referent]).
CONCLUSIONS: Outpatient follow-up within 14 days after HF exacerbation requiring hospitalization or emergency department visit is associated with better outcomes, particularly if the follow-up is with a familiar physician.
PMID: 27618853 [PubMed - in process]