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Temporal Trends and Variation in Early Scheduled Follow-Up After a Hospitalization for Heart Failure: Findings from Get With The Guidelines-Heart Failure. | LitMetric
From the Department of Medicine (A.D.D., Z.J.E., E.D.P., A.F.H.) and Duke Clinical Research Institute (A.D.D. M.C., Z.J.E., E.D.P., A.F.H.), Duke University School of Medicine, Durham, NC; Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); Department of Medicine, Brigham and Women's Hospital, Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Veterans Affairs Palo Alto Health Care System, CA (P.A.H.); Stanford University, CA (P.A.H.); and Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.).
Published: January 2016
AI Article Synopsis
Article Abstract
Background: Previous data demonstrate early follow-up (ie, within 7 days of discharge) after a hospitalization for heart failure is associated with a lower risk of readmission, yet is uncommon and varies widely across hospitals. Limited data exist on whether the use of early follow-up after discharge has improved over time.
Methods And Results: We used data from Get With The Guidelines-Heart Failure (GWTG-HF) linked to Medicare claims to examine temporal trends in early follow-up and to assess for patient and hospital characteristics associated with early scheduled follow-up. In the overall GWTG-HF cohort, we studied 52,438 patients discharged from 239 hospitals from 2009 to 2012. Scheduled early follow-up at the time of hospital discharge rose from 51% to 65% over time (P<0.001). After multivariable adjustment, patients with older age (odds ratio, 1.04; 95% confidence interval, 1.01-1.07), certain comorbidities (anemia, diabetes mellitus, and chronic kidney disease), and the use of anticoagulation at discharge (odds ratio, 1.16; 95% confidence interval, 1.11-1.22) were associated with greater likelihood for early scheduled follow-up. Patients treated in hospitals located in the Midwest (odds ratio, 0.67; 95% confidence interval, 0.50-0.91) were less likely to have early scheduled follow-up. In a subset of patients with linked Medicare claims, we observed smaller improvements in actual early follow-up visits over time from 26% to 30% (P=0.005).
Conclusions: From 2009 to 2012, there was improvement in early scheduled outpatient follow-up and, in the subset analyzed, improvement in actual early follow-up visits for hospitalized patients with heart failure. However, substantial opportunities remain for improving heart failure transitional care.
