In the Journals

Early follow-up, physician continuity may boost HF survival

Early physician follow-up after discharge and physician continuity were associated with lower mortality and urgent hospital readmission among patients with HF, according to results from an observational study.

Previous research has demonstrated that physician follow-up within 30 days of discharge was associated with lower rates of death and readmission for patients with HF. In the new study, Findlay A. McAlister, MD, MSc, of the University of Alberta, Edmonton, Canada, and colleagues investigated whether physician continuity provided any further benefit.

The researchers reviewed data from four health care databases in Alberta to identify 24,373 patients who were discharged alive after a first-time diagnosis of HF from January 1999 to June 2009. The patients were grouped as follows: no follow-up visits within 30 days of discharge; at least one follow-up visit with a familiar physician within 30 days of discharge; at least one follow-up visit with an unfamiliar physician. The researchers defined a familiar physician as one a patient had seen at least once during the index admission or at least twice in the year before the index admission. If a patient had seen both a familiar physician and an unfamiliar physician within 30 days after discharge, the patient was placed in the familiar group.

The primary outcome was death or urgent hospital readmission for any reason within 6 months after discharge. Elective readmissions were not included.

Within 30 days of discharge, 21.9% of HF patients had no follow-up visits, 69.2% had at least one visit with a familiar physician and 9% saw only unfamiliar physicians. The risk for death or unplanned readmission within 6 months was higher for those with no follow-up visits after 30 days (62.9%) compared with those who saw a familiar physician (43.6%; adjusted HR=0.87; 95% CI, 0.83-0.91) or an unfamiliar physician (43.6%; adjusted HR=0.9; 95% CI, 0.83-0.97).

When all follow-up visits within 6 months of discharge were analyzed, the researchers found that those who had follow-up visits with a familiar physician exclusively had a lower risk for death or unplanned readmission than those who did not (adjusted HR=0.91, 95% CI, 0.85-0.98).

“We believe that physicians should strive to optimize continuity with their [HF] patients after discharge and that strategies are needed in the health care system to ensure early follow-up after discharge with the patient’s regular physician,” McAlister and colleagues wrote.

Disclosure: The study was funded by grants from the Canadian Institutes of Health Research and Pfizer Canada. McAlister and two other researchers are supported by salary awards from Alberta Innovates — Health Solutions.

Early physician follow-up after discharge and physician continuity were associated with lower mortality and urgent hospital readmission among patients with HF, according to results from an observational study.

Previous research has demonstrated that physician follow-up within 30 days of discharge was associated with lower rates of death and readmission for patients with HF. In the new study, Findlay A. McAlister, MD, MSc, of the University of Alberta, Edmonton, Canada, and colleagues investigated whether physician continuity provided any further benefit.

The researchers reviewed data from four health care databases in Alberta to identify 24,373 patients who were discharged alive after a first-time diagnosis of HF from January 1999 to June 2009. The patients were grouped as follows: no follow-up visits within 30 days of discharge; at least one follow-up visit with a familiar physician within 30 days of discharge; at least one follow-up visit with an unfamiliar physician. The researchers defined a familiar physician as one a patient had seen at least once during the index admission or at least twice in the year before the index admission. If a patient had seen both a familiar physician and an unfamiliar physician within 30 days after discharge, the patient was placed in the familiar group.

The primary outcome was death or urgent hospital readmission for any reason within 6 months after discharge. Elective readmissions were not included.

Within 30 days of discharge, 21.9% of HF patients had no follow-up visits, 69.2% had at least one visit with a familiar physician and 9% saw only unfamiliar physicians. The risk for death or unplanned readmission within 6 months was higher for those with no follow-up visits after 30 days (62.9%) compared with those who saw a familiar physician (43.6%; adjusted HR=0.87; 95% CI, 0.83-0.91) or an unfamiliar physician (43.6%; adjusted HR=0.9; 95% CI, 0.83-0.97).

When all follow-up visits within 6 months of discharge were analyzed, the researchers found that those who had follow-up visits with a familiar physician exclusively had a lower risk for death or unplanned readmission than those who did not (adjusted HR=0.91, 95% CI, 0.85-0.98).

“We believe that physicians should strive to optimize continuity with their [HF] patients after discharge and that strategies are needed in the health care system to ensure early follow-up after discharge with the patient’s regular physician,” McAlister and colleagues wrote.

Disclosure: The study was funded by grants from the Canadian Institutes of Health Research and Pfizer Canada. McAlister and two other researchers are supported by salary awards from Alberta Innovates — Health Solutions.