Regular physician follow-up may be crucial to post-discharge HF

When it comes to improving outcomes after hospitalization for heart failure (HF), early and regular physician follow-up could be a critical factor. Canadian researchers found that mortality risk and the chances for urgent readmission were lower among HF patients who saw a physician within 30 days of discharge, especially if they saw a physician who cared for them at least twice in the year before their initial admission. Using data from adults 20 years of age and older in the province of Alberta discharged between January 1999 and June 2009 after a first-time diagnosis of HF, the researchers compared patients who saw their regular physician, a new physician or no physician after discharge. Of the 24,373 patients, 21.9 percent had no follow-up visits, 69.2 percent saw a physician who cared for them previously and 9 percent saw a new physician. The risk of dying or being suddenly readmitted was lower for patients who saw a familiar physician (43.6 percent, 0.87 hazard ratio) or a new physician (43.6 percent, 0.9 hazard ratio) when compared with patients who did not seek early follow-up (62.9 percent). “The transition from hospital back to the community is particularly risky for patients with heart failure,” wrote the authors, led by Finlay A. McAlister, MD, MSc, of the University of Alberta in Edmonton. “Our findings showed that prompt follow-up within 30 days after discharge and physician continuity were both important modulators of the risk of death or urgent readmission in this patient group.” During the early follow-up period, there was no significant difference in mortality or readmission risk between patients who saw a familiar physician or an unfamiliar one. However, the risks were significantly different in the six months after discharge. More than 75 percent of the patients did receive follow-up care within 30 days of discharge and on average, they saw their doctors twice a month. Of the patients who followed up early, 88.5 percent saw a familiar physician. “Patients seen by familiar physician(s) in the first month were more likely to have diabetes, atrial fibrillation or hypertension and had more physician visits in the year before the index admission compared with the rest of the study cohort,” the authors explained. They added that future study should address the importance of physician continuity in patients with other medical conditions and under circumstances other than hospital discharge. They said their findings, however, should encourage physicians to be diligent about post-discharge care for HF patients. “[P]hysicians should strive to optimize continuity with their heart-failure patients after discharge,” they wrote. “[S]trategies are needed in the health care system to ensure early follow-up after discharge with the patient's regular physician.”