Follow-up Key for Heart Failure Survival

Heart failure patients who see a doctor in first month after hospital stay improve survival odds

(RxWiki News) Heart failure is one of the most common reasons for admission to the hospital. A visit to the doctor after a hospital stay for heart failure may reduce both the likelihood of readmission and the risk of early death.

Every year, more than $20 billion is spent on patients in the United States and Canada who are readmitted to the hospital within 30 days of discharge.

A new study found that if heart failure patients see a physician within the first month after leaving the hospital, they can decrease the chances of a return trip to the hospital and increase their chances for survival.

If they see a doctor they know (as opposed to one they don’t), the outcomes may be even better.

"Visit a doctor soon after a hospital stay for heart failure."

Finlay McAlister, MD, professor in the Division of General Internal Medicine at the University of Alberta in Edmonton, and coauthors examined data on 24,373 patients from Alberta who were discharged from the hospital with a first-time diagnosis of heart failure between 1999 and 2009.

Although “heart failure” may sound like the heart is no longer working at all, it is actually a condition where the heart is not pumping enough to meet the body’s needs for blood and oxygen, according to the American Heart Association.

In the first month after leaving the hospital, 5,336 patients (about 22 percent) had no follow-up visits; 16,855 (about 69 percent) saw a familiar physician; and 2,182 (9 percent) had a check-up with an unfamiliar physician.

Regardless of whether the follow-up was with a familiar or unfamiliar physician, patients who had early follow-up had a lower risk of death or urgent readmission to the hospital over the following six months compared to those who had no doctor visits in the first month after discharge.

The investigators noted, however, “When we examined follow-up patterns throughout the six months after discharge, continuity with a familiar physician was associated with a lower risk of death or readmission than follow-up with an unfamiliar physician.”

Dr. McAlister told dailyRx News that for patients who saw any physician in the first month after hospital discharge, there were 7 percent fewer deaths and readmissions at one month and 20 percent fewer deaths and readmissions at three months (that figure became an 8 percent reduction after accounting for baseline imbalances).

If the patients were seeing a familiar physician in the first month, there were 11 percent fewer deaths and readmissions within one month and 22 percent fewer deaths and readmissions by three months (that figure became a 12 percent reduction after accounting for baseline imbalances).

The results of this study confirm earlier research from Duke University in North Carolina, which showed that the risk of 30-day readmission and death was lower for heart patients who had early physician follow-up.

“We believe that physicians should strive to optimize continuity with their heart failure patients after discharge and that strategies are needed in the healthcare system to ensure early follow-up after discharge with the patient's regular physician," Dr. McAlister and his team concluded.

"Heart failure treatment has become a focus due to the high cost of treatment, especially when they need hospital care. Patients with heart failure tend to get admitted to a hospital for worsening symptoms, so anything that can be done to prevent this from occurring is interest of the medical community," Dr. Jeffrey Schussler, a board certified General and Interventional Cardiologist and the medical director for the CVICU at the Baylor University Medical Center, Jack and Jane Hamilton Heart and Vascular Hospital, told dailyRx News.

"The period of time after a patient with heart failure is discharged from the hospital tends to be a critical one, so it makes sense that getting that patient in to see a doctor relatively quickly would reduce the need for a return and a re-admission," said Dr. Schussler. 

This study was published August 19 in CMAJ (Canadian Medical Association Journal).

Review Date: 
August 19, 2013