Timely Follow-Up After a First Diagnosis of Cirrhosis is Associated With Reduced Mortality but No Impact on Rehospitalisations: A Population-Based Cohort of 8852 Patients.
cirrhosis
follow‐up
rehospitalisation
transitions of care
Journal
Alimentary pharmacology & therapeutics
ISSN: 1365-2036
Titre abrégé: Aliment Pharmacol Ther
Pays: England
ID NLM: 8707234
Informations de publication
Date de publication:
01 Oct 2024
01 Oct 2024
Historique:
revised:
13
07
2024
received:
06
06
2024
accepted:
18
09
2024
medline:
2
10
2024
pubmed:
2
10
2024
entrez:
2
10
2024
Statut:
aheadofprint
Résumé
Timely transition of care amongst patients with a first diagnosis of cirrhosis in a hospital to an outpatient visit is important. We evaluated rates of outpatient follow-up after a first diagnosis of cirrhosis during an inpatient setting, and its association with subsequent rates of rehospitalisation and mortality. We conducted a population-based cohort study identifying all hospitalised patients in Sweden diagnosed with cirrhosis between 2002 and 2020 from the Swedish National Patient Register. The primary outcome was any outpatient visit related to cirrhosis within 90 days after hospital discharge. Secondary outcomes were rates of rehospitalisation and mortality within 1 year of discharge in patients receiving outpatient follow-up within 90 days or not. Cox regression was used for all analyses, and incidence rates per 1000 person-years were calculated for mortality and rehospitalisation. Of 8852 patients, 3759 (42%) had outpatient follow-up within 90 days of discharge. Patients who received follow-up within 90 days of discharge were younger, had a higher level of education and were more likely to have liver decompensation or hepatocellular carcinoma compared to those without timely follow-up. We found that follow-up within 90 days was associated with lower rates of all-cause mortality within 1 year (aHR = 0.86, 95%CI = 0.78-0.96) but with no significant impact on rehospitalisations (aHR = 0.97, 95%CI = 0.91-1.03). In Sweden, 42% of hospitalised patients with newly diagnosed cirrhosis receive outpatient follow-up within 90 days of their hospital discharge. These patients may experience lower mortality but no change in rehospitalisations within 1 year.
Sections du résumé
BACKGROUND AND AIMS
OBJECTIVE
Timely transition of care amongst patients with a first diagnosis of cirrhosis in a hospital to an outpatient visit is important. We evaluated rates of outpatient follow-up after a first diagnosis of cirrhosis during an inpatient setting, and its association with subsequent rates of rehospitalisation and mortality.
METHODS
METHODS
We conducted a population-based cohort study identifying all hospitalised patients in Sweden diagnosed with cirrhosis between 2002 and 2020 from the Swedish National Patient Register. The primary outcome was any outpatient visit related to cirrhosis within 90 days after hospital discharge. Secondary outcomes were rates of rehospitalisation and mortality within 1 year of discharge in patients receiving outpatient follow-up within 90 days or not. Cox regression was used for all analyses, and incidence rates per 1000 person-years were calculated for mortality and rehospitalisation.
RESULTS
RESULTS
Of 8852 patients, 3759 (42%) had outpatient follow-up within 90 days of discharge. Patients who received follow-up within 90 days of discharge were younger, had a higher level of education and were more likely to have liver decompensation or hepatocellular carcinoma compared to those without timely follow-up. We found that follow-up within 90 days was associated with lower rates of all-cause mortality within 1 year (aHR = 0.86, 95%CI = 0.78-0.96) but with no significant impact on rehospitalisations (aHR = 0.97, 95%CI = 0.91-1.03).
CONCLUSIONS
CONCLUSIONS
In Sweden, 42% of hospitalised patients with newly diagnosed cirrhosis receive outpatient follow-up within 90 days of their hospital discharge. These patients may experience lower mortality but no change in rehospitalisations within 1 year.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Author(s). Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.
Références
H. Devarbhavi, S. K. Asrani, J. P. Arab, Y. A. Nartey, E. Pose, and P. S. Kamath, “Global Burden of Liver Disease: 2023 Update,” Journal of Hepatology 79, no. 2 (2023): 516–537, https://doi.org/10.1016/j.jhep.2023.03.017.
A. Smith, K. Baumgartner, and C. Bositis, “Cirrhosis: Diagnosis and Management,” American Family Physician 100, no. 12 (2019): 759–770.
A. N. Amin, P. H. Nguyen, and E. B. Tapper, “Missed Diagnosis of Cirrhosis in the Inpatient Setting,” Journal of Hospital Medicine 17 (2022): S1–S7, https://doi.org/10.1002/jhm.12918.
A. Moghe, V. Yakovchenko, T. Morgan, et al., “Strategies to Improve Delivery of Cirrhosis Care,” Current Treatment Options in Gastroenterology 19, no. 2 (2021): 369–379, https://doi.org/10.1007/s11938‐021‐00345‐y.
F. Kanwal, S. M. Asch, J. R. Kramer, Y. Cao, S. Asrani, and H. B. El‐Serag, “Early Outpatient Follow‐Up and 30‐Day Outcomes in Patients Hospitalized With Cirrhosis,” Hepatology 64, no. 2 (2016): 569–581, https://doi.org/10.1002/hep.28558.
B. P. Morales, R. Planas, R. Bartoli, et al., “HEPACONTROL. A Program That Reduces Early Readmissions, Mortality at 60 Days, and Healthcare Costs in Decompensated Cirrhosis,” Digestive and Liver Disease 50, no. 1 (2018): 76–83, https://doi.org/10.1016/j.dld.2017.08.024.
Z. Szakács, B. Erőss, A. Soós, et al., “Baveno Criteria Safely Identify Patients With Compensated Advanced Chronic Liver Disease Who Can Avoid Variceal Screening Endoscopy: A Diagnostic Test Accuracy Meta‐Analysis,” Frontiers in Physiology 10 (2019): 1028, https://doi.org/10.3389/fphys.2019.01028.
A. Kardashian, A. A. Patel, E. S. Aby, et al., “Identifying Quality Gaps in Preventive Care for Outpatients With Cirrhosis Within a Large, Academic Health Care System,” Hepatology Communications 4, no. 12 (2020): 1802–1811, https://doi.org/10.1002/hep4.1594.
F. Kanwal, E. B. Tapper, C. Ho, et al., “Development of Quality Measures in Cirrhosis by the Practice Metrics Committee of the American Association for the Study of Liver Diseases,” Hepatology 69, no. 4 (2019): 1787–1797, https://doi.org/10.1002/hep.30489.
A. Berzigotti, E. Tsochatzis, J. Boursier, et al., “EASL Clinical Practice Guidelines on Non‐Invasive Tests for Evaluation of Liver Disease Severity and Prognosis—2021 Update,” Journal of Hepatology 75, no. 3 (2021): 659–689, https://doi.org/10.1016/j.jhep.2021.05.025.
European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO), “EASL–EASD–EASO Clinical Practice Guidelines for the Management of Non‐Alcoholic Fatty Liver Disease,” Journal of Hepatology 64, no. 6 (2016): 1388–1402, https://doi.org/10.1016/j.jhep.2015.11.004.
H. Hagström, Y. Shang, A. Wester, and L. Widman, “Cohort Profile: Decoding the Epidemiology of Liver Disease in Sweden (DELIVER),” Scandinavian Journal of Gastroenterology 57, no. 8 (2022): 978–983, https://doi.org/10.1080/00365521.2022.2051202.
B. Bengtsson, J. Askling, J. F. Ludvigsson, and H. Hagström, “Validity of Administrative Codes Associated With Cirrhosis in Sweden,” Scandinavian Journal of Gastroenterology 55, no. 10 (2020): 1205–1210, https://doi.org/10.1080/00365521.2020.1820566.
L. Barlow, K. Westergren, L. Holmberg, and M. Talbäck, “The Completeness of the Swedish Cancer Register—A Sample Survey for Year 1998,” Acta Oncologica 48, no. 1 (2009): 27–33, https://doi.org/10.1080/02841860802247664.
H. Toyoda, T. Kumada, S. Kiriyama, et al., “Markedly Lower Follow‐Up Rate After Liver Biopsy in Patients With Non‐alcoholic Fatty Liver Diseases Than Those With Viral Hepatitis in Japan,” BMC Research Notes 4, no. 1 (2011): 341, https://doi.org/10.1186/1756‐0500‐4‐341.
H. Hagström, L. A. Adams, A. M. Allen, et al., “The Future of International Classification of Diseases Coding in Steatotic Liver Disease: An Expert Panel Delphi Consensus Statement,” Hepatology Communications 8, no. 2 (2024): e0386, https://doi.org/10.1097/HC9.0000000000000386.
M. Serper, E. B. Tapper, D. E. Kaplan, T. H. Taddei, and N. Mahmud, “Patterns of Care Utilization and Hepatocellular Carcinoma Surveillance: Tracking Care Across the Pandemic,” American Journal of Gastroenterology 118, no. 2 (2023): 294–303, https://doi.org/10.14309/ajg.0000000000002011.
F. I. Lieveld, J. E. Arends, L. Amelung, et al., “Overcoming Outpatient Loss to Follow‐Up as a Barrier to Efficiently Instituting Hepatitis B Liver‐Related Care,” Clinical Infectious Diseases 64, no. 2 (2017): 233–235, https://doi.org/10.1093/cid/ciw746.
P. Angeli, M. Bernardi, C. Villanueva, et al., “EASL Clinical Practice Guidelines for the Management of Patients With Decompensated Cirrhosis,” Journal of Hepatology 69, no. 2 (2018): 406–460, https://doi.org/10.1016/j.jhep.2018.03.024.
H. Hagström, A. Lindfors, M. Holmer, et al., “Etiologies and Outcomes of Cirrhosis in a Large Contemporary Cohort,” Scandinavian Journal of Gastroenterology 56, no. 6 (2021): 727–732, https://doi.org/10.1080/00365521.2021.1912167.
P. Nasr, E. von Seth, R. Mayerhofer, N. Ndegwa, J. F. Ludvigsson, and H. Hagström, “Incidence, Prevalence and Mortality of Chronic Liver Diseases in Sweden Between 2005 and 2019,” European Journal of Epidemiology 38, no. 9 (2023): 973–984, https://doi.org/10.1007/s10654‐023‐01028‐x.
J. F. Ludvigsson, E. Andersson, A. Ekbom, et al., “External Review and Validation of the Swedish National Inpatient Register,” BMC Public Health 11, no. 1 (2011): 450, https://doi.org/10.1186/1471‐2458‐11‐450.