cover image: 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

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

7 Dec 2023

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, &#x27E8;10.1002/ejhf.3103&#x27E9;. &#x27E8;hal-04329446&#x27E9;
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

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