Early Follow-Up After a Heart Failure Exacerbation: The Importance of Continuity.
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.



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 inthose who sawan 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 withunfamiliar 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]).



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.
From the Division of General Internal Medicine (F.A.M.), Patient Health Outcomes Research and Clinical Effectiveness Unit (F.A.M., E.Y.), and Division of Cardiology, Mazankowski Alberta Heart Institute (P.K., J.A.E.), University of Alberta, Edmonton, Canada. Finlay.McAlister@ualberta.ca.
Finlay A
FA
McAlister
From the Division of General Internal Medicine (F.A.M.), Patient Health Outcomes Research and Clinical Effectiveness Unit (F.A.M., E.Y.), and Division of Cardiology, Mazankowski Alberta Heart Institute (P.K., J.A.E.), University of Alberta, Edmonton, Canada.
Erik
E
Youngson
From the Division of General Internal Medicine (F.A.M.), Patient Health Outcomes Research and Clinical Effectiveness Unit (F.A.M., E.Y.), and Division of Cardiology, Mazankowski Alberta Heart Institute (P.K., J.A.E.), University of Alberta, Edmonton, Canada.
Padma
P
Kaul
From the Division of General Internal Medicine (F.A.M.), Patient Health Outcomes Research and Clinical Effectiveness Unit (F.A.M., E.Y.), and Division of Cardiology, Mazankowski Alberta Heart Institute (P.K., J.A.E.), University of Alberta, Edmonton, Canada.
Justin A
JA
Ezekowitz
D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D000553:Ambulatory Care; D016009:Chi-Square Distribution; D003266:Continuity of Patient Care; D003695:Delivery of Health Care; D018450:Disease Progression; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D010343:Patient Admission; D010351:Patient Discharge; D010817:Physician-Patient Relations; D016016:Proportional Hazards Models; D021641:Recognition, Psychology; D012189:Retrospective Studies; D013997:Time Factors
continuity of patient care; emergency service, hospital; health services research; heart failure; physicians