Risk of readmission and death after hospitalization for worsening heart failure: Role of post-discharge follow-up visits in a real-world study from the Grand Est Region of France.
Cardiovascular diseases
Epidemiology
Healthcare pathways
Heart failure
Survival
Journal
European journal of heart failure
ISSN: 1879-0844
Titre abrégé: Eur J Heart Fail
Pays: England
ID NLM: 100887595
Informations de publication
Date de publication:
07 Dec 2023
07 Dec 2023
Historique:
revised:
13
11
2023
received:
24
07
2023
accepted:
26
11
2023
medline:
7
12
2023
pubmed:
7
12
2023
entrez:
7
12
2023
Statut:
aheadofprint
Résumé
Patients who experience hospitalizations due to heart failure (HF) face a significant risk of readmission and mortality. Our objective was to evaluate whether the risk of hospitalization and mortality following discharge from HF hospitalization differed based on adherence to the outpatient follow-up (FU) protocol comprising an appointment with a general practitioner (GP) within 15 days, a cardiologist within 2 months or both (termed combined FU). We studied all adults admitted for a first HF hospitalization from 2016 to 2020 in France's Grand Est region. Association between adherence to outpatient FU and outcomes were assessed with time-dependent survival analysis model. Among 67 476 admitted patients (mean age 80.3 ± 11.3 years, 53% women), 62 156 patients (92.2%) were discharged alive and followed for 723 (317-1276) days. Combined FU within 2 months was used in 21.1% of patients, with lower rates among >85 years, women, and those with higher comorbidity levels (p < 0.0001 for all). Combined FU was associated with a lower one-year death or rehospitalization (adjusted HR = 0.91, 0.88-0.94, p < 0.0001) mostly related to lower mortality (adjusted HR = 0.65, 0.62-0.68, p < 0.0001) whereas HF readmission was higher (adjusted HR = 1.19, 1.15-1.24, p < 0.0001). When analyzing components of combined FU separately, one-year mortality was more related to cardiologist FU (HR = 0.65, 0.62 to 0.67, p < 0.0001), than GP FU (HR = 0.87, 0.85 to 0.90, p < 0.0001). Combined follow-up is carried out in a minority of patients following HF hospitalization, yet it is linked to a substantial reduction in one-year mortality, albeit at the expense of an increase in HF hospitalizations. This article is protected by copyright. All rights reserved.
Sections du résumé
BACKGROUND AND AIMS
OBJECTIVE
Patients who experience hospitalizations due to heart failure (HF) face a significant risk of readmission and mortality. Our objective was to evaluate whether the risk of hospitalization and mortality following discharge from HF hospitalization differed based on adherence to the outpatient follow-up (FU) protocol comprising an appointment with a general practitioner (GP) within 15 days, a cardiologist within 2 months or both (termed combined FU).
METHODS
METHODS
We studied all adults admitted for a first HF hospitalization from 2016 to 2020 in France's Grand Est region. Association between adherence to outpatient FU and outcomes were assessed with time-dependent survival analysis model.
RESULTS
RESULTS
Among 67 476 admitted patients (mean age 80.3 ± 11.3 years, 53% women), 62 156 patients (92.2%) were discharged alive and followed for 723 (317-1276) days. Combined FU within 2 months was used in 21.1% of patients, with lower rates among >85 years, women, and those with higher comorbidity levels (p < 0.0001 for all). Combined FU was associated with a lower one-year death or rehospitalization (adjusted HR = 0.91, 0.88-0.94, p < 0.0001) mostly related to lower mortality (adjusted HR = 0.65, 0.62-0.68, p < 0.0001) whereas HF readmission was higher (adjusted HR = 1.19, 1.15-1.24, p < 0.0001). When analyzing components of combined FU separately, one-year mortality was more related to cardiologist FU (HR = 0.65, 0.62 to 0.67, p < 0.0001), than GP FU (HR = 0.87, 0.85 to 0.90, p < 0.0001).
CONCLUSION
CONCLUSIONS
Combined follow-up is carried out in a minority of patients following HF hospitalization, yet it is linked to a substantial reduction in one-year mortality, albeit at the expense of an increase in HF hospitalizations. This article is protected by copyright. All rights reserved.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023 European Society of Cardiology.