Temporal Trends and Variation in Early Scheduled Follow-Up After a Hospitalization for Heart Failure: Findings from Get With The Guidelines-Heart Failure

Circ Heart Fail. 2016 Jan;9(1):e002344. doi: 10.1161/CIRCHEARTFAILURE.115.002344.

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.

Keywords: heart failure; hospital readmission; outpatients; transitional care.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Ambulatory Care / trends*
  • Appointments and Schedules*
  • Catchment Area, Health
  • Chi-Square Distribution
  • Female
  • Guideline Adherence / trends*
  • Healthcare Disparities / trends
  • Heart Failure / diagnosis
  • Heart Failure / therapy*
  • Humans
  • Male
  • Medicare
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Patient Discharge / trends*
  • Practice Guidelines as Topic*
  • Practice Patterns, Physicians' / trends*
  • Quality Indicators, Health Care / trends
  • Registries
  • Residence Characteristics
  • Time Factors
  • Transitional Care / trends*
  • United States