Early Follow-up of Heart Failure Patients After Discharge Reduces Readmissions

Heart failure patients who have early follow-up with general medicine or cardiology providers within 7 days of discharge from the hospital had 19% had lower odds of readmission within 30 days, a new study from Kaiser Permanente physicians suggests. The study, published in Medical Care, followed 11,985 patients at a large, integrated healthcare delivery system in Northern California from January 2006 through June 2013. Heart failure poses a substantial health and economic burden nationally and is expected to grow significantly in the future, the authors note.

The patients were adults with a primary diagnosis of heart failure. All were discharged to home without hospice care. There were 1587 cases of patients being readmitted to the hospital within the first 30 days after discharge who were matched with 7935 patients who were not readmitted to the hospital within 30 days. Follow-up care was defined as outpatient visits and telephone calls with cardiology and general medicine providers in nonemergency and nonurgent care settings.

After adjusting for differences in patient sociodemographic and clinical characteristics, acute severity of illness, hospitalization characteristics, and postdischarge medication changes and lab testing, the researchers found that early initial outpatient contact within 7 days of discharge was associated with lower odds of readmission to hospitals within 30 days. Later outpatient contact, between 8 and 30 days after discharge, was not significantly associated with readmission.

Initial contact with patients by telephone was associated with lower adjusted odds of 30-day readmission, but the difference was not significant. Although all clinic visits were with physicians, the researchers said it was important to note that 45% of the follow-up telephone calls were made by nonphysician providers who were trained to follow an outpatient heart failure treatment protocol.

“Our study showed that the timing of follow-up after hospitalization for heart failure is an important factor,” said lead author Keane K. Lee, MD, MS, a cardiologist and research scientist with Kaiser Permanente. “Early follow-up within seven days, even with a telephone call, was associated with lower risk of readmission, whereas follow-up after seven days was not associated with this benefit.”

The study authors said their findings suggest that clinicians may be able to reduce hospital readmissions in high-risk patients by improving transitional care and making use of the increasing integration occurring in the healthcare system today, which includes electronic medical records and a coordinated approach to care among all types of providers across inpatient and outpatient settings.