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. Pina, Adrian Hernandez, Gregg C. Fonarow, Adam D. DeVore

Research output: Contribution to journalArticle

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 1 2019

Fingerprint

Outpatients
Heart Failure
Mortality
Confidence Intervals
Comorbidity
Primary Health Care
Chronic Renal Insufficiency
Chronic Obstructive Pulmonary Disease
Diabetes Mellitus
Medicare
Guidelines

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Edmonston, D. L., Wu, J., Matsouaka, R. A., Yancy, C., Heidenreich, P., Pina, I. L., ... 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

Association of post-discharge specialty outpatient visits with readmissions and mortality in high-risk heart failure patients. / Edmonston, Daniel L.; Wu, Jingjing; Matsouaka, Roland A.; Yancy, Clyde; Heidenreich, Paul; Pina, Ileana L.; Hernandez, Adrian; Fonarow, Gregg C.; DeVore, Adam D.

In: American Heart Journal, Vol. 212, 01.06.2019, p. 101-112.

Research output: Contribution to journalArticle

Edmonston, DL, Wu, J, Matsouaka, RA, Yancy, C, Heidenreich, P, Pina, IL, Hernandez, A, Fonarow, GC & DeVore, AD 2019, 'Association of post-discharge specialty outpatient visits with readmissions and mortality in high-risk heart failure patients', American Heart Journal, vol. 212, pp. 101-112. https://doi.org/10.1016/j.ahj.2019.03.005
Edmonston, Daniel L. ; Wu, Jingjing ; Matsouaka, Roland A. ; Yancy, Clyde ; Heidenreich, Paul ; Pina, Ileana L. ; Hernandez, Adrian ; Fonarow, Gregg C. ; DeVore, Adam D. / Association of post-discharge specialty outpatient visits with readmissions and mortality in high-risk heart failure patients. In: American Heart Journal. 2019 ; Vol. 212. pp. 101-112.
@article{633c97a9492848afbd9ec214dc2ec898,
title = "Association of post-discharge specialty outpatient visits with readmissions and mortality in high-risk heart failure patients",
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.",
author = "Edmonston, {Daniel L.} and Jingjing Wu and Matsouaka, {Roland A.} and Clyde Yancy and Paul Heidenreich and Pina, {Ileana L.} and Adrian Hernandez and Fonarow, {Gregg C.} and DeVore, {Adam D.}",
year = "2019",
month = "6",
day = "1",
doi = "10.1016/j.ahj.2019.03.005",
language = "English (US)",
volume = "212",
pages = "101--112",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Association of post-discharge specialty outpatient visits with readmissions and mortality in high-risk heart failure patients

AU - Edmonston, Daniel L.

AU - Wu, Jingjing

AU - Matsouaka, Roland A.

AU - Yancy, Clyde

AU - Heidenreich, Paul

AU - Pina, Ileana L.

AU - Hernandez, Adrian

AU - Fonarow, Gregg C.

AU - DeVore, Adam D.

PY - 2019/6/1

Y1 - 2019/6/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85063969615&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85063969615&partnerID=8YFLogxK

U2 - 10.1016/j.ahj.2019.03.005

DO - 10.1016/j.ahj.2019.03.005

M3 - Article

C2 - 30978555

AN - SCOPUS:85063969615

VL - 212

SP - 101

EP - 112

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

ER -