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Impact of Early Follow-Up on Mortality and Readmissions After Emergency Care of HF Cohort
Study Questions:
What is the optimal timing of physician follow-up after emergency department discharge for heart failure (HF)?
Methods:
A retrospective cohort study was conducted with adult (age ≥18 years) patients who had a primary diagnosis of HF and who were discharged from 1 of 163 emergency departments in Ontario, Canada, between April 2007 and March 2014. Patients were identified using the Canadian Institutes of Health Information National Ambulatory Care Reporting System, and these patient data were linked to institutional data, zip codes, and neighborhood income data. Propensity score-matched landmark analysis was used to assess associations between patient follow-up and hospital readmission and death for cardiovascular conditions.
Results:
From the data analyzed for 34,519 patients, 16,274 (47.1%) and 28,846 (83.6%) patients received follow-up care within 7 and 30 days, respectively. Patients who received follow-up care within 7 days had a lower death rate over 1 year (hazard ratio [HR] .92; 95% confidence interval [CI], .87-.97) and reduced 90-day (HR .87; 95% CI, .80-.94) and 1-year (HR .92; 95% CI, .87-.97) rehospitalization rates compared with those with follow-up between 8 and 30 days; 90-day mortality trended to lower rates among those who had follow-up care within 7 days, as well (HR .90; 95% CI, .10-1.00). Follow-up care within 30 days of emergency department discharge (vs. without 30-day follow-up) was associated with reduced 1-year mortality (HR .89; 95% CI, .82-.97) but not hospitalization (HR 1.02; 95% CI, .94-1.10); in this group, there was a trend toward increased 90-day hospitalization (HR 1.14; 95% CI, 1.00-1.29).
Conclusions:
In this study cohort, less than half of the patients with acute HF symptoms who presented to and were discharged from the emergency department received physician follow-up care within 1 week of discharge. Subsequent hospitalization and death rates due to cardiovascular conditions were lower in patients who received early (within 7 days) follow-up care compared with those who received follow-up care between 8 and 30 days or longer after emergency department discharge. Ensuring that patients receive early follow-up care appointments following an emergency department visit is crucial to improving outcomes.
Perspective:
Studies on hospital readmission and mortality outcomes among patients hospitalized with acute decompensated HF dominate the literature. In this study, the timing of follow-up care of patients treated in and then discharged from the emergency department had a significant impact on outcomes (readmission and death rates); however, findings across studies have been inconsistent, making interpretation difficult. Studies that systematically prioritize scheduling follow-up care appointments after emergency department visits similar to those after inpatient hospital stays are needed to ensure guideline-based care.
Keywords: Heart Failure, Aftercare, Emergency Service, Hospital, Hospitalization, Patient Discharge, Patient Readmission
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