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Follow-up care after ED visit for HF decreases readmission rate, death
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Patients who followed up within 1 week of being discharged from the ED for HF had a reduced rate of readmission to the hospital and death, according to a study published in the Canadian Medical Association Journal.
Clare Atzema, MD, MSc, FRCPC, scientist at Sunnybrook Research Institute in Toronto, and colleagues analyzed data from 34,519 patients from the Canadian Institutes of Health Information National Ambulatory Care Reporting System who visited the ED between April 2007 and March 2014 with a primary diagnosis of HF. Researchers also analyzed the use of guideline-directed medical therapy 1 year after HF presentation.
The primary outcome of interest was all-cause mortality at 1 year. Secondary outcome measures of interest included all-cause mortality at 90 days and admission to the hospital at 90 days and 1 year.
Of the patients in the study, 47.1% received follow-up care within 7 days of hospital discharge and 83.6% received follow-up care within 30 days of discharge.
Patients who received follow-up care within 7 days had a reduced risk for 1-year mortality compared with those who received care between 8 and 30 days (HR = 0.92; 95% CI, 0.87-0.97). These patients also had a reduced rate of admission over 90 days (HR = 0.87; 95% CI, 0.8-0.94) and 1 year after discharge (HR = 0.92; 95% CI, 0.87-0.97). The rate of mortality at 90 days was also lower in patients who received follow-up care within 7 days (HR = 0.9; 95% CI, 0.1-1).
Compared with patients who did not receive follow-up care at 30 days, those who did had a reduction in mortality at 1 year (HR = 0.89; 95% CI, 0.82-0.97). The rate of hospital admission was not reduced in these patients (HR = 1.02; 95% CI, 0.94-1.1). In fact, the researchers wrote, patients who received follow-up care within 30 days had an increase in hospital admission within 90 days (HR = 1.14; 95% CI, 1-1.29).
“This study provides evidence to support the timing of follow-up care for an expanding population of patients,” Atzema and colleagues wrote. “Obtaining early follow-up for all of these patients will require a transition in systematic care between emergency and longitudinal care, via collaboration between administrators, researchers, clinicians and information technology specialists.” – by Darlene Dobkowski
Disclosures: The authors report no relevant financial disclosures.
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