Early Follow-Up May Reduce Hospital Readmission in Patients with COPD, Heart Failure

Therese A. Stukel, PhD

New findings suggest early follow-up in combination with a traditional care strategy for hospitalized patients with medically complex conditions and ongoing effective chronic disease management may reduce 90-day hospital readmissions.

Data show that early follow-up with a primary care physician was associated with fewer readmissions for patients with congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD), but no benefit at 30 days was observed for those with acute myocardial infarction (AMI).

“Less than half of patients discharged from an Ontario hospital after an admission did not see a physician within 7 days, and the percentages did not change over 15 years despite the importance of early follow-up,” wrote corresponding study author Therese A. Stukel, PhD, ICES.

Stukel and fellow investigators set out to assess whether hospitalized patients with AMI, CHF, or COPD who had physician follow-up within 7 days after discharge had lower rates of readmission at 30 and 90 days in Ontario, Canada.

They identified the exposure as an ambulatory visit or telephone call with a primary care physician or relevant specialist within 7 days of discharge. The primary outcomes were 30-day and 90-day unplanned all-cause and condition-specific readmission after index admission discharge, with mortality as a second outcome.

The study cohort consisted of 450,746 patients in Ontario, Canada including 198,854 patients with AMI, 133,058 patients with CHF, and 118,834 patients with COPD. Median age of 66 years for AMI, 78 years for CHF, and 73 years for COPD, with 64,339 (32.35%) women, 62,575 (47.03%) women, and 59,179 (49.80%) women, respectively.

From this population, investigators identified 91,182 patients (45.85%), 56,491 patients (42.46%), and 40,159 patients (33.79%), respectively, who received an early follow-up visit.

Individuals who received a 7-day physician follow-up visit were more than 2-fold as likely to receive collaborative care within 30 days (CHF: 20,931 patients [37.85%] vs 11,101 patients [14.85%]) and visits to a specialist within 30 days (CHF: 25,797 [45.67%] vs 20,548 patients [26.84%]).

Those with 7-day follow-up had fewer readmissions within 90 days among patients with CHF (15,934 patients [28.21% vs 23,121 patients [30.20%]; adjusted hazard ratio [aHR], 0.98; 95% CI, 0.96 - 0.99) and COPD (8784 patients [21.87%] vs 18,097 patients [23.00%]; aHR, 0.95; 95% CI, 0.93 - 0.98) compared to those without follow-up.

Moreover, patients with CHF and early follow-up had lower 90-day mortality rates (4044 patients [7.16%] vs 6281 patients [8.20%]; aHR, 0.93; 95% CI, 0.90-0.97).

Investigators noted early postdischarge visits may be important in maximizing the reduction in adverse events associated with treatment for those with medically complex conditions.

“However, these visits need to be part of a comprehensive transitional care strategy coupled with ongoing effective chronic disease management encompassing care coordination among multiple sectors of the healthcare system and providing comprehensive, patient-centered care that addresses coexisting illness,” Stukel added.

The study, “Association of Early Physician Follow-up With Readmission Among Patients Hospitalized for Acute Myocardial Infarction, Congestive Heart Failure, or Chronic Obstructive Pulmonary Disease,” was published in JAMA Network Open.