Department of Medicine, School of Medicine University of Alabama at Birmingham Birmingham AL USA.
Department of Epidemiology, School of Public Health University of Alabama at Birmingham Birmingham AL USA.
J Am Heart Assoc. 2023 Jun 20;12(12):e029094. doi: 10.1161/JAHA.122.029094. Epub 2023 Jun 7.
Background Ambulatory follow-up for all patients with heart failure (HF) is recommended within 7 to 14 days after hospital discharge to improve HF outcomes. We examined postdischarge ambulatory follow-up of patients with comorbid diabetes and HF from a low-income population in primary and specialty care. Methods and Results Adults with diabetes and first hospitalizations for HF, covered by Alabama Medicaid in 2010 to 2019, were included and the claims analyzed for ambulatory care use (any, primary care, cardiology, or endocrinology) within 60 days after discharge using restricted mean survival time regression and negative binomial regression. Among 9859 Medicaid-covered adults with diabetes and first hospitalization for HF (mean age, 53.7 years; SD, 9.2 years; 47.3% Black; 41.8% non-Hispanic White; 10.9% Hispanic/Other [Other included non-White Hispanic, American Indian, Pacific Islander and Asian adults]; 65.4% women, 34.6% men), 26.7% had an ambulatory visit within 0 to 7 days, 15.2% within 8 to 14 days, 31.3% within 15 to 60 days, and 26.8% had no visit; 71% saw a primary care physician and 12% a cardiology physician. Black and Hispanic/Other adults were less likely to have any postdischarge ambulatory visit (<0.0001) or the visit was delayed (by 1.8 days, =0.0006 and by 2.8 days, =0.0016, respectively) and were less likely to see a primary care physician than non-Hispanic White adults (adjusted incidence rate ratio, 0.96 [95% CI, 0.91-1.00] and 0.91 [95% CI, 0.89-0.98]; respectively). Conclusions More than half of Medicaid-covered adults with diabetes and HF in Alabama did not receive guideline-concordant postdischarge care. Black and Hispanic/Other adults were less likely to receive recommended postdischarge care for comorbid diabetes and HF.
建议心力衰竭（HF）患者在出院后 7 至 14 天内进行门诊随访，以改善 HF 结局。我们研究了来自低收入人群的合并糖尿病和 HF 的患者在初级保健和专科护理中的出院后门诊随访情况。
纳入了 2010 年至 2019 年期间接受亚拉巴马州医疗补助计划覆盖的患有糖尿病且首次因 HF 住院的成年人，使用限制平均生存时间回归和负二项回归分析出院后 60 天内的门诊护理使用情况（任何、初级保健、心脏病学或内分泌学）。在 9859 名接受亚拉巴马州医疗补助计划覆盖的患有糖尿病且首次因 HF 住院的成年患者中（平均年龄 53.7 岁，标准差 9.2 岁；47.3%为黑人；41.8%为非西班牙裔白人；10.9%为西班牙裔/其他[其他包括非白西班牙裔、美国印第安人、太平洋岛民和亚裔成年人]；65.4%为女性，34.6%为男性），26.7%的患者在 0 至 7 天内进行了门诊就诊，15.2%在 8 至 14 天内就诊，31.3%在 15 至 60 天内就诊，26.8%的患者没有就诊；71%的患者看了初级保健医生，12%的患者看了心脏病学医生。黑人及西班牙裔/其他成年人更不可能进行任何出院后的门诊随访（<0.0001）或门诊随访延迟（分别延迟 1.8 天，P=0.0006 和延迟 2.8 天，P=0.0016），且比非西班牙裔白人更不可能看初级保健医生（调整后的发病率比，0.96[95%CI，0.91-1.00]和 0.91[95%CI，0.89-0.98]；分别）。
亚拉巴马州接受医疗补助计划覆盖的患有糖尿病和 HF 的成年人中，超过一半的患者没有接受符合指南的出院后护理。黑人及西班牙裔/其他成年人更不可能接受合并糖尿病和 HF 的推荐出院后护理。
