Lack of Timely Follow-up Care After Heart Failure Common in Type 2 Diabetes

Yulia Khodneva, MD, PhD
Credit: University of Alabama at Birmingham

A new study of adults with type 2 diabetes using Medicaid details a grim reality: less than 50% of these adults receive follow-up care within the recommended period following a first-time hospitalization for heart failure.

An analysis of more than 9800 adult patients with type 2 diabetes a first-time hospitalization for heart failure covered by Alabama Medicaid, results of the study suggest just 41.6% of patients had an ambulatory follow-up within the recommended 14 days after hospitalization, with more than 1 in 4 going 60 days or more without seeing a care provider following hospitalization. Results of the study, which had a patient population where more than 47% of people were African American Adults, also shed light on racial disparities in follow-up care.

“The study underscores a necessity to develop interventions that will facilitate guideline-directed treatment and care for patients with Type 2 diabetes and heart failure, especially for those with Medicaid or people of underrepresented races and ethnicities,” said lead investigator Yulia Khodneva, MD, PhD, an assistant professor of medicine and primary care physician at the University of Alabama School of Medicine in Birmingham.²

The current study was a retrospective secondary analysis of Medicaid claims data collected within the Alabama Care Plan study. An observational study aimed at evaluating the quality of care for diabetes among Alabama Medicaid beneficiaries, the study provided Khdoneva and fellow investigators with data related to a cohort of 9859 adult patients with type 2 diabetes and first hospitalization for heart failure from 2010-2019.¹

This cohort had a mean age at discharge of 53.7 (SD, 9.2) years, 41.8% were non-Hispanic White, 47.3% were Black, 10.9% were Hispanic or Asian, Native American, Pacific Islander, or other. Investigators noted 19.7% of the cohort had a rural residence and the primary reason for Medicaid eligibility among the cohort was disability, accounting for 92.4% of the eligibility.¹

The primary outcome of interest for the analysis was ambulatory care use within 60 days after discharge. For the purpose of analysis, ambulatory care use was defined as first primary care visit, first cardiology visit, and first endocrinology care visit within the 60‐day post-discharge period. Investigators further stratified patients based on visits within the 60-day follow-up period, with these groups defined as those who had any ambulatory care visits with 0-7 days after discharge, those who had any ambulatory care visits 8-14 days after discharge, those who had any ambulatory care visits within 15-60 days after discharge and those with no ambulatory care vistas within 60 days after discharge.¹

Upon analysis, results indicated 26.7% of the study cohort had an ambulatory visit within 0-7 days, 15.2% had a visit within 8-14 days, 31.3% had a visit within 15-60 days, and 26.8% had no visit recorded. Among those with a visit, 71% saw a primary care physician, 12% a cardiology physician, and 1.6% an endocrinologist. Investigators noted participants were seen sooner in primary care setting (median time to visit, 13 days [IQR, 5-25]) than in cardiology (19 days [IQR, 7-35]) or endocrinology (26 days [IQR, 11-37]).¹

Further analysis revealed Black and Hispanic/Other adults were less likely than their non-Hispanic White counterparts to have any post-discharge ambulatory visit (P < .0001). Additionally, Black and Hispanic/Other adults who did have visits experienced delays (1.8 days, P = .0006 and by 2.8 days, P = .0016, respectively) and were less likely to be see by a primary care physician than their non-Hispanic White counterparts (adjusted incidence rate ratio, 0.96 [95% CI, 0.91-1.00] and 0.91 [95% CI, 0.89-0.98]; respectively).¹

“Hopefully, this study will trigger additional, more in-depth studies that may help to explain the reasons for these observed racial disparities and help in the development of interventions to promote prompt follow-up for these patients,” Khodneva said.²

References:

1. Khodneva Y, Levitan EB, Arora P, Presley CA, Oparil S, Cherrington AL. Disparities in Postdischarge Ambulatory Care Follow-Up Among Medicaid Beneficiaries With Diabetes, Hospitalized for Heart Failure [published online ahead of print, 2023 Jun 7]. J Am Heart Assoc. 2023;e029094. doi:10.1161/JAHA.122.029094
2. Lack of timely follow-up after heart failure hospitalization for most adults with diabetes. American Heart Association. June 7, 2023. Accessed June 7, 2023. https://newsroom.heart.org/news/lack-of-timely-follow-up-after-heart-failure-hospitalization-for-most-adults-with-diabetes.