Goyal Parag, Sterling Madeline R, Beecy Ashley N, Ruffino John T, Mehta Sonal S, Jones Erica C, Lachs Mark S, Horn Evelyn M
Division of Cardiology, Department of Medicine.
Department of Medicine.
Clin Interv Aging. 2016 Sep 26;11:1325-1332. doi: 10.2147/CIA.S113442. eCollection 2016.
Although postdischarge outpatient follow-up appointments after a hospitalization for heart failure represent a potentially effective strategy to prevent heart failure readmissions, patterns of scheduled follow-up appointments upon discharge are poorly described. We aimed to characterize real-world patterns of scheduled follow-up appointments among adult patients with heart failure upon hospital discharge.
This was a retrospective cohort study performed at a large urban academic center in the United States among adults hospitalized with a principal diagnosis of congestive heart failure between January 1, 2013, and December 31, 2014. Patient demographics, administrative data, clinical parameters, echocardiographic indices, and scheduled postdischarge outpatient follow-up appointments were collected.
Of the 796 patients hospitalized for heart failure, just over half of the cohort had a scheduled follow-up appointment upon discharge. Follow-up appointments were less likely among patients who were white and had heart failure with preserved ejection fraction and more likely among patients with Medicaid and chronic obstructive pulmonary disease. In an adjusted multivariable regression model, age ≥65 years was inversely associated with a scheduled follow-up appointment upon hospital discharge, despite higher rates of several cardiovascular and noncardiovascular comorbidities.
Just half of the patients discharged home following a hospitalization for heart failure had a follow-up appointment scheduled, representing a missed opportunity to provide a recommended care transition intervention. Despite a greater burden of both cardiovascular and noncardiovascular comorbidities, older adults (age ≥65 years) were less likely to have a follow-up appointment scheduled upon discharge compared with younger adults, revealing a disparity that warrants further investigation.
尽管心力衰竭住院后出院门诊随访预约是预防心力衰竭再入院的一种潜在有效策略，但出院时预定随访预约的模式描述甚少。我们旨在描述成年心力衰竭患者出院时预定随访预约的真实模式。
这是一项在美国一个大型城市学术中心进行的回顾性队列研究，研究对象为2013年1月1日至2014年12月31日期间因充血性心力衰竭为主诊断而住院的成年人。收集了患者人口统计学资料、管理数据、临床参数、超声心动图指标以及出院后预定的门诊随访预约信息。
在796例因心力衰竭住院的患者中，略超过半数的队列患者出院时有预定的随访预约。白人且射血分数保留的心力衰竭患者进行随访预约的可能性较小，而有医疗补助和慢性阻塞性肺疾病的患者进行随访预约的可能性较大。在调整后的多变量回归模型中，尽管存在多种心血管和非心血管合并症，但年龄≥65岁与出院时预定随访预约呈负相关。
心力衰竭住院后出院回家的患者中只有一半安排了随访预约，这意味着错失了提供推荐的护理过渡干预的机会。尽管心血管和非心血管合并症负担更重，但与年轻成年人相比，老年人（年龄≥65岁）出院时安排随访预约的可能性较小，这一差异值得进一步研究。
