Early follow-up after a heart failure exacerbation

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 in those who saw an 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 with unfamiliar 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.