Heart Failure: Impact of Physician Continuity after Discharge

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https://medicalresearch.com/heart-disease/heart-failure-impact-of-physician-continuity-after-discharge/1474/

Dr. Finlay McAlister Division of General Internal Medicine Patient Health Outcomes Research and Clinical Effectiveness Unit University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.MedicalResearch.com Interview with:
Dr. Finlay McAlister
Division of General Internal Medicine
Patient Health Outcomes Research and Clinical Effectiveness Unit
University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.

MedicalResearch.com: What are the main findings of the study?

Answer: Heart Failure carries a high risk of readmission/death in the first 30 days after hospital discharge (approximately 20%) – even in this cohort of patients with first time diagnosis of heart failure who were discharged home to the community.  Patients who do not have an outpatient physician follow-up visit in the first 30 days after discharge have poorer outcomes at 30 days, 3 months, 6 months, and 12 months.  Although outcomes are similar for patients who see an unfamiliar or a familiar physician in that first 30 days, over the longer term follow-up with a familiar physician is associated with better outcomes than follow-up with unfamiliar physician(s).

MedicalResearch.com: Were any of the findings unexpected?

Answer: I was surprised that follow-up with a familiar physician was more beneficial than follow-up with any physician – current guidelines recommend follow-up within any physician within 30 days of discharge.

MedicalResearch.com: What should clinicians and patients take away from your report?

Answer: The transition from hospital to home is a high-risk situation for patients with heart failure and it is important to have outpatient follow-up within that first month after discharge to ensure successful transition, optimization of medications, etc.  While follow-up with any physician is beneficial, follow-up with a physician familiar with the patient is even more beneficial (familiar defined as having seen the patient at least twice as an outpatient prior to their heart failure hospitalization or during their heart failure hospitalization).

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Answer: My study only examined the impact of physician continuity after a discharge for heart failure.  Future studies should examine whether this relationship also exists for patients with other medical conditions and whether it applies in settings other than recent hospital discharge.

Citation:

Finlay A. McAlister, Erik Youngson, Jeffrey A. Bakal, Padma Kaul, Justin Ezekowitz, and Carl van Walraven

Impact of physician continuity on death or urgent readmission after discharge among patients with heart failure CMAJ cmaj.130048; published ahead of print August 19, 2013, doi:10.1503/cmaj.130048

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