Abstract
Heart failure (HF) outcomes are especially poor in high-risk patients with certain comorbidities including diabetes mellitus (DM), chronic kidney disease (CKD), and chronic obstructive pulmonary disease (COPD). Whether early specialty or primary care provider (PCP) follow-up after HF discharge affects outcomes in high-risk patients is unknown. Methods: We analyzed patients discharged from a Get With The Guidelines HF-participating hospital from 2007–2012 with linked Medicare claims to investigate the association of medical specialist visit within 14 days of discharge stratified by comorbidity with the primary outcome of 90-day HF readmission. Secondary outcomes included 90-day and 1-year all-cause mortality. Results: Out of 33,243 patients, 39.4% had DM, 19.8% had CKD, 30.0% had COPD, and 36.3% had no key comorbidity. Nephrologist visit in patients with CKD was associated with a 35% reduction in 90-day HF readmission (hazard ratio [HR] 0.65, 95% confidence interval [CI] 0.49–0.85). Pulmonologist visit in patients with COPD was associated with a 29% reduction in 90-day HF readmission (HR 0.71, 95% CI 0.55–0.91). In patients with no key comorbidity, PCP and Cardiologist visits were associated with decreased 90-day mortality (HR for PCP 0.79, 95% CI 0.66–0.94; HR for Cardiologist 0.78, 95% CI 0.63–0.96). In patients with DM, Endocrinologist visit was associated with a 42% reduction of 90-day mortality (HR 0.58, 95% CI 0.34–0.99). Conclusions: Specialist and PCP visit in the immediate post-discharge period may improve 90-day HF readmission and mortality in certain high-risk groups of patients with HF.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 101-112 |
| Number of pages | 12 |
| Journal | American heart journal |
| Volume | 212 |
| DOIs | |
| State | Published - Jun 2019 |
Funding
This work was supported by an AHA grant award number 16SFRN30180010 . The GWTG-HF program is provided by the AHA. GWTG-HF is sponsored, in part, by Amgen Cardiovascular and has been funded in the past through support from Medtronic, GlaxoSmithKline, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable. The Duke Clinical Research Institute coordinated all data management and statistical analyses for this project. All analyses were performed using SAS software version 9.4. The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the manuscript, and its final contents. Consultant at the Food and Drug Administration, Center for Devices and Radiological Health, and Office of Device Evaluation (I.P.). Research support from the AHA, AstraZeneca, Merck, National Heart, Lung, and Blood Institute, Luitpold, and Novartis, and honorarium from Bayer, Boston Scientific, and Novartis (A.H.). Research funding from the National Institutes of Health and consulting for Amgen, Janssen, Novartis, Medtronic, and St Jude Medical (G.F.). Research funding from the American Heart Association, Amgen, the National Heart, Lung, and Blood Institute and Novartis and serving as a consultant for Novartis (A.D.). The other authors report no conflicts or competing interests.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
