Background and Aims Patients who experience hospitalizations due to heart failure (HF) face a significant risk of readmission and mortality. Our objective was to evaluate whether the risk of hospitalization and mortality following discharge from HF hospitalization differed based on adherence to the outpatient follow-up (FU) protocol comprising an appointment with a general practitioner (GP) within 15 days, a cardiologist within 2 months or both (termed combined FU). Methods We studied all adults admitted for a first HF hospitalization from 2016 to 2020 in France's Grand Est region. Association between adherence to outpatient FU and outcomes were assessed with time-dependent survival analysis model. Results Among 67476 admitted patients (mean age 80.3±11.3 years, 53% women), 62156 patients (92.2%) were discharged alive and followed for 723 (317-1276) days. Combined FU within 2 months was used in 21.1% of patients, with lower rates among >85 years, women, and those with higher comorbidity levels (p<0.0001 for all). Combined FU was associated with a lower one-year death or rehospitalization (adjusted HR=0.91, 0.88-0.94, p<0.0001) mostly related to lower mortality (adjusted HR=0.65, 0.62-0.68, p<0.0001) whereas HF readmission was higher (adjusted HR=1.19, 1.15-1.24, p<0.0001). When analyzing components of combined FU separately, one-year mortality was more related to cardiologist FU (HR=0.65, 0.62 to 0.67, p<0.0001), than GP FU (HR=0.87, 0.85 to 0.90, p<0.0001). Conclusion Combined follow-up is carried out in a minority of patients following HF hospitalization, yet it is linked to a substantial reduction in one-year mortality, albeit at the expense of an increase in HF hospitalizations.
Authors
Guillaume Baudry, Ouarda Pereira, Kévin Duarte, João Pedro Ferreira, Gianluigi Savarese, Adeline Welter, Philippe Tangre, Zohra Lamiral, Nelly Agrinier, Nicolas Girerd
- Bibliographic Reference
- Guillaume Baudry, Ouarda Pereira, Kévin Duarte, João Pedro Ferreira, Gianluigi Savarese, et al.. Risk of readmission and death after hospitalization for worsening heart failure: Role of post-discharge follow-up visits in a real-world study from the Grand Est Region of France. European Journal of Heart Failure, 2023, ⟨10.1002/ejhf.3103⟩. ⟨hal-04329446⟩
- DOI
- https://doi.org/10.1002/ejhf.3103
- HAL Collection
- ['Université de Lorraine', 'DCAC - Défaillance Cardiovasculaire Aiguë et Chronique', 'Pôle scientifique Biologie, Médecine, Santé']
- HAL Identifier
- 4329446
- Institution
- ['Centre Hospitalier Régional Universitaire de Nancy', 'Institut National de la Santé et de la Recherche Médicale', 'Université de Lorraine', 'French-Clinical Research Infrastructure Network - F-CRIN [Paris]', 'Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy]', 'REICATRA, Recherche et Enseignement en IC Avancée, Transplantation, Assistance', 'Direction Régionale du Service Médical (DRSM) Grand Est, Strasbourg, France', 'Karolinska Institutet [Stockholm]', 'Direction de la Coordination de la Gestion du Risque (DCGDR) Grand Est', 'Caisse Nationale d’Assurance Maladie', 'Université de Lorraine, APEMAC']
- Laboratory
- ['Défaillance Cardiovasculaire Aiguë et Chronique', "Centre d'investigation clinique plurithématique Pierre Drouin [Nancy]", 'Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy]']
- Published in
- France
Table of Contents
- Risk of readmission and death after hospitalization for worsening heart failure Role of post-discharge follow-up visits in a real-world study from the Grand Est Region of France 1
- Abstract 249 words 3
- Background and Aims 3
- Methods 3
- Results 3
- Conclusion 3
- Keywords 3
- Introduction 4
- Materials and methods 4
- Population and study design 4
- Outcomes 5
- Groups based on post-discharge follow-up 5
- Definition of covariates 5
- Statistical analysis 5
- Ethical statement 6
- Results 7
- Patients characteristics and post-discharge follow-up 7
- Association of GP cardiologist or combined follow-up with hospital readmission 7
- Association between combined follow-up and outcomes according to age category 8
- Sensitivity analysis after the exclusion of patients who died within 2 months. 8
- Sensitivity analysis by income level according to access to complementary universal 8
- Sensitivity analysis using propensity score to account for baseline differences 8
- Discussion 9
- Epidemiology and determinants associated with healthcare follow-up 9
- Effect of combined follow-up on mortality 10
- Effect of combined follow-up on hospitalization 10
- Impact in clinical practice 11
- Limitations 11
- Conclusion 12
- Acknowledgments 12
- Funding statement 12
- Conflict of interest 13
- Data availability statement 13
- References 14
- Tables 21
- Table 1 Baseline characteristics of the study population 21
- Table 2 Initial occurrence of events of interest after discharge 22
- Table 3 Multivariate analysis of parameters associated with post-discharge follow-up 24
- Table 4 Association of GP Cardiologist and combined follow-up with one-year and long-term outcome in Cox regression 25
- Table 5 Association of GP Cardiologist and combined follow-up with one-year and long-term outcome in Cox regression after 26
- Figures 27
- Figure 1 Event curves for one-year mortality A and one-year heart failure rehospitalization B according to follow-up FU 27
- Figure 2 Association between combined follow-up and mortality A and rehospitalization B at one-year according to age 29
- 044 29
- 069 073 29
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- 55 55-64 65-74 75-84 85 29
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- 55 55-64 65-74 75-84 85 30
- Graphical Abstract 31
- Supplementary material 32
- Supplementary Table 1 Multivariate analysis of parameters associated with post-discharge follow-up excluding patients who died 32
- Supplementary Table 2 Association between combined follow-up and outcomes according to age category 33
- Supplementary Table 3 Association of GP Cardiologist and combined follow-up with one-year and long-term outcome in Cox 33
- Supplementary Table 4 Association of GP cardiologist and combined follow-up with one-year and long-term outcome in Cox 34
- Supplementary Table 5 Interaction between complementary universal medical coverage status and combined FU dependent-time 34
- Supplementary Table 6 Baseline characteristics according to follow-up before and after inverse probability weighting 35
- Supplementary Figure 1 Event curves for mortality A and heart failure rehospitalization B according to follow-up FU 36
