Physician Continuity Improves Outcomes for Heart Failure Patients Treated and Released From the Emergency Department

Abstract

Early follow-up after an ED visit is associated with better outcomes, particularly if conducted with a familiar physician.

Early Follow-Up After a Heart Failure Exacerbation

“…We have previously shown that follow-up in the first month after a hospitalization or emergency department (ED) visit for HF with physicians familiar with that patient is associated with lower rates of subsequent hospitalization or ED visits over the next 6 months than early follow-up with another physician. 6,7 However, it is unknown whether continuity of care within the first 2 weeks after a hospitalization/ED visit influences outcomes in the 30-day timeframe emphasized in the Affordable Care Act. We included patients who were seen in an ED and those discharged from the hospital because up to one third of HF exacerbations in Alberta are treated and released from the ED.…”

“…We included patients who were seen in an ED and those discharged from the hospital because up to one third of HF exacerbations in Alberta are treated and released from the ED. 7 …”

“…Similar to previous studies, 3,6,7 for our primary analysis, the physician continuity classification was locked-in at the end of the first 14 days (or at the time of an outcome event if it occurred within the first 14 days) and did not take into account further outpatient visits during the remainder of the observation period for each patient. In a sensitivity analysis, we defined follow-up on the basis of the first 7 days after the index HF visit, again using time-varying covariate analyses.…”

Letter by McAlister and Ezekowitz Regarding Article, “Temporal Trends and Variation in Early Scheduled Follow-Up After a Hospitalization for Heart Failure: Findings From Get With the Guidelines-Heart Failure”

“…We have previously shown that (in Canada) early follow-up after a hospitalization or emergency department visit for heart failure with physicians familiar with a particular patient is associated with lower readmission rates than early follow-up with any physician. 4,5 Are the investigators able to determine what proportion of early follow-up appointments in Get With The Guidelines-Heart Failure hospitals were planned to be with a physician who had been involved with the patient's care either before or during the index hospitalization? We think that continuity of care is one of the fundamental building blocks for any high-performing healthcare system and that the current guideline's emphasis on prompt follow-up after hospitalizations or emergency department visits may lead to system changes that neglect the importance of continuity.…”

Team-based Care for Patients Hospitalized with Heart Failure

“…25 In a recent retrospective study of more than 12,000 patients treated and discharged from the ED for HF, the rate of death or all-cause hospitalization at 6 months was 11% lower in those who saw a familiar physician in the first month versus those with no outpatient visits, and 15% lower than those with visits only with unfamiliar physicians. 26 …”