Association of post-discharge specialty outpatient visits with readmissions and mortality in high-risk heart failure patients

Daniel L. Edmonston, Jingjing Wu, Roland A. Matsouaka, Clyde Yancy, Paul Heidenreich, Ileana L. Piña, Adrian Hernandez, Gregg C. Fonarow, Adam D. DeVore

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Abstract

Heart failure (HF) outcomes are especially poor in high-risk patients with certain comorbidities including diabetes mellitus (DM), chronic kidney disease (CKD), and chronic obstructive pulmonary disease (COPD). Whether early specialty or primary care provider (PCP) follow-up after HF discharge affects outcomes in high-risk patients is unknown. Methods: We analyzed patients discharged from a Get With The Guidelines HF-participating hospital from 2007–2012 with linked Medicare claims to investigate the association of medical specialist visit within 14 days of discharge stratified by comorbidity with the primary outcome of 90-day HF readmission. Secondary outcomes included 90-day and 1-year all-cause mortality. Results: Out of 33,243 patients, 39.4% had DM, 19.8% had CKD, 30.0% had COPD, and 36.3% had no key comorbidity. Nephrologist visit in patients with CKD was associated with a 35% reduction in 90-day HF readmission (hazard ratio [HR] 0.65, 95% confidence interval [CI] 0.49–0.85). Pulmonologist visit in patients with COPD was associated with a 29% reduction in 90-day HF readmission (HR 0.71, 95% CI 0.55–0.91). In patients with no key comorbidity, PCP and Cardiologist visits were associated with decreased 90-day mortality (HR for PCP 0.79, 95% CI 0.66–0.94; HR for Cardiologist 0.78, 95% CI 0.63–0.96). In patients with DM, Endocrinologist visit was associated with a 42% reduction of 90-day mortality (HR 0.58, 95% CI 0.34–0.99). Conclusions: Specialist and PCP visit in the immediate post-discharge period may improve 90-day HF readmission and mortality in certain high-risk groups of patients with HF.

Original languageEnglish (US)
Pages (from-to)101-112
Number of pages12
JournalAmerican heart journal
Volume212
DOIs
StatePublished - Jun 2019

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Edmonston, D. L., Wu, J., Matsouaka, R. A., Yancy, C., Heidenreich, P., Piña, I. L., Hernandez, A., Fonarow, G. C., & DeVore, A. D. (2019). Association of post-discharge specialty outpatient visits with readmissions and mortality in high-risk heart failure patients. American heart journal, 212, 101-112. https://doi.org/10.1016/j.ahj.2019.03.005