Early follow-up reduces heart failure readmissions

Having a follow-up appointment with a physician within a week of being discharged from a hospital with a diagnosis of heart failure appears to reduce a patient's risk of readmission, according to a comparison of hospitals.

The observational analysis used data from the OPTIMIZE-HF and Get with the Guidelines programs to compare how many of the hospitals' heart failure patients saw a physician within a week of leaving the hospital.

The study population included more than 30,000 patients treated at 225 hospitals between 2003 and 2006. The hospitals were divided into quartiles based on follow-up rates; those results were then compared with rates of readmission within 30 days. To control for individual patient factors that might confound the association between follow-up and outcomes, hospital-wide statistics were analyzed. The results were published in the May 5 Journal of the American Medical Association.

Overall, more than 20% of the patients were readmitted within the month. Most patients also didn't have a follow-up appointment within a week. The median percentage across the hospitals was only 38.3%. In the quartile of hospitals with the worst follow-up rates, the readmission rate was 23.3% in 30 days, compared to just under 21% in the other three quartiles.

The study also found that most patients had their follow-up appointment with a general internist; less than 10% saw a cardiologist within a week. The vast majority of patients (94%) also did have an outpatient appointment scheduled while they were in the hospital, although the study did not look at how soon those appointments were.

The findings highlight the need for improved coordination of care between inpatient and outpatient settings, the study authors concluded. They noted that the narrowing of the scope of medical practice makes this coordination more difficult, but they suggested the models of care using nurse practitioners or physician assistants could improve access to timely follow-up care. The authors also said that early follow-up after discharge could be used in the future as a marker of quality in heart failure performance measure sets.