Division of General Internal Medicine, University of Pittsburgh, and Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (T.S.A.).
Division of Cardiology and Smith Center for Cardiovascular Outcomes Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts (R.W.Y.).
Ann Intern Med. 2024 Sep;177(9):1190-1198. doi: 10.7326/M23-3475. Epub 2024 Aug 6.
Timely follow-up after cardiovascular hospitalization is recommended to monitor recovery, titrate medications, and coordinate care.
To describe trends and disparities in follow-up after acute myocardial infarction (AMI) and heart failure (HF) hospitalizations.
Retrospective cohort study.
Medicare.
Medicare fee-for-service beneficiaries hospitalized between 2010 and 2019.
Receipt of a cardiology visit within 30 days of discharge. Multivariable logistic regression models were used to estimate changes over time overall and across 5 sociodemographic characteristics on the basis of known disparities in cardiovascular outcomes.
The cohort included 1 678 088 AMI and 4 245 665 HF hospitalizations. Between 2010 and 2019, the rate of cardiology follow-up increased from 48.3% to 61.4% for AMI hospitalizations and from 35.2% to 48.3% for HF hospitalizations. For both conditions, follow-up rates increased for all subgroups, yet disparities worsened for Hispanic patients with AMI and patients with HF who were Asian, Black, Hispanic, Medicaid dual eligible, and residents of counties with higher levels of social deprivation. By 2019, the largest disparities were between Black and White patients (AMI, 51.9% vs. 59.8%, difference, 7.9 percentage points [pp] [95% CI, 6.8 to 9.0 pp]; HF, 39.8% vs. 48.7%, difference, 8.9 pp [CI, 8.2 to 9.7 pp]) and Medicaid dual-eligible and non-dual-eligible patients (AMI, 52.8% vs. 60.4%, difference, 7.6 pp [CI, 6.9 to 8.4 pp]; HF, 39.7% vs. 49.4%, difference, 9.6 pp [CI, 9.2 to 10.1 pp]). Differences between hospitals explained 7.3 pp [CI, 6.7 to 7.9 pp] of the variation in follow-up for AMI and 7.7 pp [CI, 7.2 to 8.1 pp]) for HF.
Generalizability to other payers.
Equity-informed policy and health system strategies are needed to further reduce gaps in follow-up care for patients with AMI and patients with HF.
National Institute on Aging.
建议对心血管住院患者进行及时的随访，以监测康复情况、调整药物剂量并协调护理。
描述急性心肌梗死（AMI）和心力衰竭（HF）住院患者随访的趋势和差异。
回顾性队列研究。
医疗保险。
2010 年至 2019 年住院的医疗保险付费服务受益人。
出院后 30 天内接受心脏病学就诊的情况。基于心血管结局存在差异的已知情况，多变量逻辑回归模型用于估计总体和 5 个社会人口统计学特征上随时间的变化。
队列包括 1678088 例 AMI 和 4245665 例 HF 住院患者。2010 年至 2019 年间，AMI 住院患者的心脏病学随访率从 48.3%增加到 61.4%，HF 住院患者的随访率从 35.2%增加到 48.3%。对于这两种疾病，所有亚组的随访率都有所增加，但西班牙裔 AMI 患者和亚裔、非裔、西班牙裔、同时享受医疗补助和医疗救助的 HF 患者以及居住在社会贫困程度较高的县的 HF 患者的差异则恶化。到 2019 年，最大的差异存在于非裔和白人患者之间（AMI，51.9%比 59.8%，差异为 7.9 个百分点[95%CI，6.8 至 9.0 个百分点]；HF，39.8%比 48.7%，差异为 8.9 个百分点[95%CI，8.2 至 9.7 个百分点]）和 Medicaid 双重资格和非双重资格患者之间（AMI，52.8%比 60.4%，差异为 7.6 个百分点[95%CI，6.9 至 8.4 个百分点]；HF，39.7%比 49.4%，差异为 9.6 个百分点[95%CI，9.2 至 10.1 个百分点]）。医院之间的差异解释了 AMI 随访变化的 7.3 个百分点[95%CI，6.7 至 7.9 个百分点]和 HF 随访变化的 7.7 个百分点[95%CI，7.2 至 8.1 个百分点]。
对其他支付者的推广性。
需要采取公平意识的政策和卫生系统策略，以进一步缩小 AMI 患者和 HF 患者在随访护理方面的差距。
美国国家老龄化研究所。
