Physician continuity important in reducing HF outcomes

Edmonton, AB - Patients hospitalized with heart failure have significantly better clinical outcomes if they are followed up with a physician early after hospital discharge, a new study shows [1]. Physician continuity, however—defined as seeing a doctor already familiar with the patient—was associated with significantly better outcomes than seeing an unfamiliar physician.
"We believe that physicians should strive to optimize continuity with their heart-failure patients after discharge and that strategies are needed in the healthcare system to ensure early follow-up after discharge with the patient"s regular physician," write Dr Findlay McAlister (University of Alberta, Edmonton) and colleagues in their report, published online August 19, 2013 in CMAJ. 

These conclusions are based on an analysis of 24 373 patients in Alberta discharged from the hospital between 1999 and 2009 with a diagnosis of heart failure. Patients were grouped into three categories based on physician continuity in their first 30 days after hospital discharge: 

• No follow-up visits. 
• At least one follow-up visit with a familiar physician, defined as a doctor who saw the patient at least twice before the index hospitalization or who treated the patient during admission. 
• At least one follow-up visit but not with a familiar physician. 

One month after discharge, 21.9% of patients had no follow-up visits, 69.2% saw a familiar physician, and 9.0% saw an unfamiliar physician. Compared with patients who had no follow-up, those who saw a familiar physician had a significant 13% lower risk of death or hospital readmission at six months. Patients who saw an unfamiliar doctor also fared better than those without any follow-up, with these patients having a significant 10% lower risk of death or hospital readmission.

In an analysis that took into account all the follow-up visits over the six-month period, patients who were treated with a familiar physician had a significant 9% lower risk of death or hospital readmission than patients who followed up with a doctor who had not treated them previously.

"The transition from hospital back to the community is particularly risky for patients with heart failure," conclude the authors. "Our findings showed that prompt follow-up within 30 days after discharge and physician continuity were both important modulators of the risk of death or urgent readmission in this patient group."