title: Temporal Trends and Variation in Early Scheduled Follow-Up After a Hospitalization for Heart Failure: Findings from Get With The Guidelines-Heart Failure.
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.
  
  
  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.
authors.affiliation: From the Department of Medicine (A.D.D., Z.J.E., E.D.P., A.F.H.) and Duke Clinical Research Institute (A.D.D. M.C., Z.J.E., E.D.P., A.F.H.), Duke University School of Medicine, Durham, NC; Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); Department of Medicine, Brigham and Women's Hospital, Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Veterans Affairs Palo Alto Health Care System, CA (P.A.H.); Stanford University, CA (P.A.H.); and Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.). adam.devore@duke.edu.
authors.forename: Adam D
authors.initials: AD
authors.lastname: DeVore
authors.affiliation: From the Department of Medicine (A.D.D., Z.J.E., E.D.P., A.F.H.) and Duke Clinical Research Institute (A.D.D. M.C., Z.J.E., E.D.P., A.F.H.), Duke University School of Medicine, Durham, NC; Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); Department of Medicine, Brigham and Women's Hospital, Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Veterans Affairs Palo Alto Health Care System, CA (P.A.H.); Stanford University, CA (P.A.H.); and Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.).
authors.forename: Margueritte
authors.initials: M
authors.lastname: Cox
authors.affiliation: From the Department of Medicine (A.D.D., Z.J.E., E.D.P., A.F.H.) and Duke Clinical Research Institute (A.D.D. M.C., Z.J.E., E.D.P., A.F.H.), Duke University School of Medicine, Durham, NC; Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); Department of Medicine, Brigham and Women's Hospital, Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Veterans Affairs Palo Alto Health Care System, CA (P.A.H.); Stanford University, CA (P.A.H.); and Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.).
authors.forename: Zubin J
authors.initials: ZJ
authors.lastname: Eapen
authors.affiliation: From the Department of Medicine (A.D.D., Z.J.E., E.D.P., A.F.H.) and Duke Clinical Research Institute (A.D.D. M.C., Z.J.E., E.D.P., A.F.H.), Duke University School of Medicine, Durham, NC; Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); Department of Medicine, Brigham and Women's Hospital, Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Veterans Affairs Palo Alto Health Care System, CA (P.A.H.); Stanford University, CA (P.A.H.); and Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.).
authors.forename: Clyde W
authors.initials: CW
authors.lastname: Yancy
authors.affiliation: From the Department of Medicine (A.D.D., Z.J.E., E.D.P., A.F.H.) and Duke Clinical Research Institute (A.D.D. M.C., Z.J.E., E.D.P., A.F.H.), Duke University School of Medicine, Durham, NC; Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); Department of Medicine, Brigham and Women's Hospital, Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Veterans Affairs Palo Alto Health Care System, CA (P.A.H.); Stanford University, CA (P.A.H.); and Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.).
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: From the Department of Medicine (A.D.D., Z.J.E., E.D.P., A.F.H.) and Duke Clinical Research Institute (A.D.D. M.C., Z.J.E., E.D.P., A.F.H.), Duke University School of Medicine, Durham, NC; Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); Department of Medicine, Brigham and Women's Hospital, Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Veterans Affairs Palo Alto Health Care System, CA (P.A.H.); Stanford University, CA (P.A.H.); and Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.).
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.affiliation: From the Department of Medicine (A.D.D., Z.J.E., E.D.P., A.F.H.) and Duke Clinical Research Institute (A.D.D. M.C., Z.J.E., E.D.P., A.F.H.), Duke University School of Medicine, Durham, NC; Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); Department of Medicine, Brigham and Women's Hospital, Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Veterans Affairs Palo Alto Health Care System, CA (P.A.H.); Stanford University, CA (P.A.H.); and Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.).
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: From the Department of Medicine (A.D.D., Z.J.E., E.D.P., A.F.H.) and Duke Clinical Research Institute (A.D.D. M.C., Z.J.E., E.D.P., A.F.H.), Duke University School of Medicine, Durham, NC; Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); Department of Medicine, Brigham and Women's Hospital, Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Veterans Affairs Palo Alto Health Care System, CA (P.A.H.); Stanford University, CA (P.A.H.); and Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.).
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: From the Department of Medicine (A.D.D., Z.J.E., E.D.P., A.F.H.) and Duke Clinical Research Institute (A.D.D. M.C., Z.J.E., E.D.P., A.F.H.), Duke University School of Medicine, Durham, NC; Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); Department of Medicine, Brigham and Women's Hospital, Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Veterans Affairs Palo Alto Health Care System, CA (P.A.H.); Stanford University, CA (P.A.H.); and Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.).
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000639:trends*; D001071:Appointments and Schedules; D002391:Catchment Area, Health; D016009:Chi-Square Distribution; D005260:Female; D019983:Guideline Adherence / Q000639:trends*; D054625:Healthcare Disparities / Q000639:trends; D006333:Heart Failure / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge / Q000639:trends*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D019984:Quality Indicators, Health Care / Q000639:trends; D012042:Registries; D012111:Residence Characteristics; D013997:Time Factors; D000069341:Transitional Care / Q000639:trends*; D014481:United States
keywords: heart failure; hospital readmission; outpatients; transitional care