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AHA Journals, Author Interviews, Heart Disease, Mayo Clinic, Women's Heart Health / 28.02.2015

dr-shannon-dunlayMedicalResearch.com Interview with: Shannon M. Dunlay, M.D. M.S. Advanced Heart Failure and Cardiac Transplantation Assistant Professor of Medicine and Health Care Policy and Research Mayo Clinic Rochester MedicalResearch: What is the background for this study? Dr. Dunlay: Loss of mobility and independence can complicate the care of patients with chronic conditions such as heart failure, and can degrade their quality of life.  However, we have a very poor understanding of the burden of disability in patients with heart failure and how it impacts outcomes.  What are the main findings?  In this study, patients with heart failure were asked whether they had difficulty performing activities of daily living (ADLs)—these include normal activities that most people do in daily life such as eating, bathing, dressing, and walking.  Most patients with heart failure reported having difficulty with at least one ADL at the beginning of the study, and over 1/3 had moderate or severe difficulty with activities of daily living.  Patients who were older, female and had other chronic conditions such as diabetes, dementia and obesity had more difficulty with activities of daily living.  Patients that reported more difficulty with ADLs (worse mobility) were more likely to die and be hospitalized over time.  Some patients had a decline in function over time, and this was also predictive of worse outcomes. (more…)
AHA Journals, Author Interviews, Gender Differences, Heart Disease, University of Pennsylvania, Women's Heart Health / 26.02.2015

Dawn Pedrotty, MD, PhD Cardiovascular Medicine Fellowship University of PennsylvaniaMedicalResearch.com Interview with: Dawn Pedrotty, MD, PhD Cardiovascular Medicine Fellowship University of Pennsylvania MedicalResearch: What is the background for this review? What are the main findings? Dr. Pedrotty: Heart failure (HF) is the most common cause for hospitalization among patients 65 years and older, affecting approximately 6 million Americans; at 40 years of age, American males and females have a one in five lifetime risk of developing heart failure. There are two distinct heart failure phenotypes: a syndrome with normal or near-normal left ventricular ejection fraction (LVEF) referred to as HF with preserved ejection fraction (HFpEF), and the phenotype associated with poor cardiac contractility or heart failure with reduced ejection fraction (HFrEF). Risk factors associated with HFpEF include female gender, especially women with diabetes, higher body mass index, smoking, hypertension, concentric left ventricular hypertrophy (LVH), and atrial fibrillation (AF). There has been a growing interest in the development of criteria for specific subsets of HFpEF, a syndromal disease where multiple cardiac and vascular abnormalities exist. One approach is to implement phenomapping, identifying phenotypically distinct HFpEF categories and developing a classification system to group together pathophysiologically similar individuals who may respond in a more homogeneous, predictable way to intervention. Another option would be to focus on a known physiologic differences which might shed light on pathologic mechanisms e.g. gender and the influences of obesity and atrial fibrillation. (more…)
AHA Journals, Author Interviews, Gender Differences, Heart Disease, Women's Heart Health / 24.02.2015

Jennifer L. Cook, MD FAHA Assistant Professor of Medicine | Heart Failure and Transplantation Medical Director Left Ventricular Assist Device Program Medical University of South Carolina Charleston, SC 29425MedicalResearch.com Interview with: Jennifer L. Cook, MD FAHA Assistant Professor of Medicine | Heart Failure and Transplantation Medical Director Left Ventricular Assist Device Program Medical University of South Carolina Charleston, SC 29425 Medical Research: What is the background for this study? What are the main findings? Dr. Cook: Although the incidence of heart failure is similar in men and women, women are more likely to die from it.  Despite this fact a common misperception persists that men are at greater risk.  Although advanced therapies such as mechanical support are as effective in women as in men, women are less likely to receive mechanical support.  In clinical trials investigating mechanical support as a bridge to transplant less than 30% of patients were women.  In trials investigating mechanical support for patients ineligible for heart transplant even fewer were women, less than 20%.  . Medical Research: What should clinicians and patients take away from your report? Dr. Cook: It has been shown that women with heart failure are more likely to remain under the care of a primary physician instead of being referred for specialized cardiovascular care.  The explanation for this pattern is not understood.  It is important to raise awareness and emphasize the high risk of heart failure mortality among women. (more…)
Author Interviews, Compliance, Emergency Care, Heart Disease / 31.01.2015

Richard J. Holden, PhD Assistant Professor Department of BioHealth Informatics Indiana University School of Informatics and Computing – Indianapolis Indianapolis, IN 46202MedicalResearch.com Interview with: Richard J. Holden, PhD Assistant Professor Department of BioHealth Informatics Indiana University School of Informatics and Computing – Indianapolis Indianapolis, IN  46202 Medical Research: What was your motivation for this study? Dr. Holden: Many patients arrive in the emergency room with acute heart failure (AHF), a worsening of their chronic heart failure condition. These visits and subsequent hospital admissions and readmissions for acute heart failure represent a sizeable cost in the US healthcare system. Evidence suggests that some of these cases could be prevented if patients were better able to perform self-care activities such as monitoring their symptoms, taking medications, getting exercise, and maintaining a sodium-restricted diet. However, in community-based studies that we and others have done, patients with heart failure face a variety of barriers to optimally performing self-care. We therefore created an instrument to assess barriers to self-care, which we designed to be implemented in the emergency room. We tested the instrument with 31 patients with acute heart failure at Vanderbilt University’s adult Emergency Department. Medical Research: What are the main findings? Dr. Holden: Almost everyone who participated reported experiencing barriers to self-care. A median of 15 barriers per patient were reported. Of the 47 barriers that we tested, 34 were reported by at least one quarter of participants. The top ten most prevalent barriers included individual-level factors such as physical disability, disease knowledge, and memory deficits as well as factors related to the organization of home life, including major disruptions such as holidays. Other barriers were related to inadequate health information, low literacy, and lack of resources. Many barriers interacted with one another, for example, lack of transportation yet not wanting to rely on others. We found that the instrument could be feasibly administered within a short period following the patient’s emergency room arrival. (more…)
AHA Journals, Author Interviews, Heart Disease, Hospital Readmissions, NYU / 16.01.2015

Leora Horwitz, MD, MHS Director, Center for Healthcare Innovation and Delivery Science New York University Langone Medical Center Director, Division of Healthcare Delivery Science Department of Population Health, NYU School of Medicine New York, NY 10016MedicalResearch.com Interview with: Leora Horwitz, MD, MHS Director, Center for Healthcare Innovation and Delivery Science New York University Langone Medical Center Director, Division of Healthcare Delivery Science Department of Population Health, NYU School of Medicine New York, NY 10016 Medical Research: What is the background for this study? What are the main findings? Dr. Horwitz: We reviewed over 1500 discharge summaries from 46 hospitals around the nation that had been collected as part of a large randomized controlled trial (Telemonitoring to Improve Heart Failure Outcomes). All summaries were of patients who were admitted with heart failure and survived to discharge. We found that not one of them met all three criteria of being timely, transmitted to the right physician and fully comprehensive in content. We also found that hospitals varied very widely in their average quality. For instance, in some hospitals, 98% of summaries were completed on the day of discharge; in others, none were. In the accompanying Data Report, we show that summaries transmitted to outside clinicians and including more key content elements are associated with lower risk of rehospitalization within 30 days of discharge. This is the first study to demonstrate an association of discharge summary quality with readmission. (more…)
Author Interviews, Heart Disease, Stroke / 28.12.2014

MedicalResearch.com Interview with: Torben Bjerregaard Larsen Associate professor, MD, PhD, FESC Aalborg University Hospital Department of Cardiology Aalborg Thrombosis Research Unit Denmark Medical Research: What is the background for this study? What are the main findings? Dr. Larsen: Heart failure is a major public health issue with an increasing prevalence. Heart failure is associated with an increased risk of stroke, also in patients without concomitant atrial fibrillation. However, recent prospective randomized controlled trials investigating the effect of antithrombotic therapy in heart failure patients in sinus rhythm revealed that the benefit of warfarin in reducing stroke was counterbalanced by an increased risk of bleeding. Whether subgroups within the heart failure population would benefit from antithrombotic therapy is currently unknown. Therefore, possible subgroups with a higher risk of stroke within the heart failure population must be identified. We investigated whether female sex was associated with a higher risk of stroke, since female sex has been associated with an increased stroke risk among patients with atrial fibrillation. In our study, we found an association between female sex and decreased stroke risk in heart failure patients in sinus rhythm which persisted after adjustment for concomitant cardiovascular risk factors. This association was attenuated with increasing age which could possibly be due to competing risks of death, since competing risk of death was substantial among males in the older age groups. (more…)
Author Interviews, Exercise - Fitness, Heart Disease / 26.11.2014

Carl "Chip" Lavie MD, FACC Medical Director, Cardiac Rehabilitation and Prevention Director, Exercise Laboratories John Ochsner Heart and Vascular Institute Professor of Medicine Ochsner Clinical School-UQ School of Medicine Editor-in-Chief, Progress in Cardiovascular DiseasesMedicalResearch.com Interview with: Carl "Chip" Lavie MD, FACC Medical  Director, Cardiac  Rehabilitation and Prevention Director, Exercise Laboratories John Ochsner Heart and Vascular Institute Professor of Medicine Ochsner Clinical  School-UQ School of Medicine Editor-in-Chief, Progress in Cardiovascular Diseases Medical Research: What are the key points of your editorial? Dr. Lavie: 1) The importance of higher fitness to predict a lower rate of developing Heart Failure; 2) improvements in fitness over  time  predict a lower rate of developing  Heart Failure, and 3) Once Heart Failure develops, higher fitness predicts a more favorable prognosis. (more…)
Author Interviews, Heart Disease / 25.11.2014

MedicalResearch.com Interview with: Dr. Eloisa Colin-Ramirez, BSc, PhD and Justin A. Ezekowitz, MBBCh MSc Associate Professor, University of Alberta Co-Director, Canadian VIGOUR Centre Director, Heart Function Clinic Cardiologist, Mazankowski Alberta Heart Institute Medical Research: What is the background for this study? What are the main findings? Response: The SODIUM-HF study is a randomized control trial on sodium restriction in patients with chronic heart failure (HF). Sodium restriction has been broadly recommended as part of the self-care strategies in heart failure yet is based on little high-quality evidence. This study reports the results of the pilot SODIUM-HF trial in 38 patients with chronic HF. Nineteen patients were prescribed a low sodium containing diet (1500 mg/day) and 19 a moderate sodium containing diet (2300 mg/day). Both interventions were based on a structured and individualized meal plan to achieve the targeted sodium intake, and all patients were followed for 6 months with monthly phone call to reinforce adherence to the diet. We found a meaningful reduction in sodium intake to less than 1500 mg/day at 6 months in both groups. Additionally, we observed that patients that achieved a sodium intake less than 1500 mg/day at 6 months of follow-up had reduced BNP levels, a biomarker of volume overload and surrogate prognostic marker in heart failure, and increased overall and clinical scores of the Kansas City Cardiomyopathy Questionnaire, compared to those with a sodium intake greater than 1500 mg/day. (more…)
Author Interviews, Heart Disease, JAMA / 19.11.2014

Dr. Lars H. Lund Department of Medicine, Karolinska Institutet Department of Cardiology, Karolinska University Hospital Stockholm, SwedenMedicalResearch.com Interview with: Dr. Lars H. Lund Department of Medicine, Karolinska Institutet Department of Cardiology, Karolinska University Hospital Stockholm, Sweden Medical Research: What is the background for this study? Dr. Lund: Heart Failure and Preserved Ejection Fraction is common and associated with poor prognosis and there is no therapy. Beta-blockers reduce mortality in Heart Failure and Preserved Ejection Fraction and we hypothesized that they may be associated with reduced mortality also in Heart Failure and Preserved Ejection Fraction. (more…)
Author Interviews, Cost of Health Care, Heart Disease, UCLA / 18.11.2014

Boback Ziaeian MD Cardiology Fellow, UCLA Division of Cardiology PhD Candidate, UCLA Fielding School of Public HealthMedicalResearch.com Interview with: Boback Ziaeian MD Cardiology Fellow, UCLA Division of Cardiology PhD Candidate, UCLA Fielding School of Public Health Medical Research: What is the background for this study? What are the main findings? Dr. Ziaeian: Heart failure is projected to increase dramatically over the coming decade due to an aging population improved medical therapies that prolong heart failure survival. Spending for heart failure is projected to increase from $20.9 billion in 2012 to $53.1 billion in 2030.  Despite the magnitude of the impact of heart failure on the US population and economy, our understanding of the factors associated with the highest cost heart failure hospitalizations is limited. Our study provides a descriptive analysis of how certain patient and hospital factors are associated with increased medical costs nationally. The top 20% of heart failure hospitalizations average $28,500 per hospitalization compared to $3,000 for the lowest 20%. Overall, patients with more medical conditions (such as obesity, lung disease, and peripheral vascular disease) have much higher costs associated with hospital care. As expected, sicker patients receiving more invasive procedures such mechanical ventilation or blood transfusions incurred higher costs. Certain hospital characteristics were also associated with higher costs. Hospitals in urban centers were higher cost compared to more rural hospitals. Hospitals in the Northeast and West Coast of the US were higher in cost compared to the Midwest and South. The reasons for this disparity in medical costs requires further research to better understand. (more…)
Author Interviews, Cleveland Clinic, Heart Disease, JACC / 29.10.2014

Professor of Medicine, Cleveland Clinic Lerner College of Medicine at CWRU Director, Cardiomyopathy Program, Kaufman Center for Heart Failure Research Director, Section of Heart Failure and Cardiac Transplantation Medicine Heart and Vascular Institute, Cleveland Clinic Cleveland, OH 44195MedicalResearch.com Interview with: W. H. Wilson Tang, MD FACC FAHA Professor of Medicine, Cleveland Clinic Lerner College of Medicine at CWRU Director, Cardiomyopathy Program, Kaufman Center for Heart Failure Research Director, Section of Heart Failure and Cardiac Transplantation Medicine Heart and Vascular Institute, Cleveland Clinic Cleveland, OH 44195 Medical Research: What are the main findings of the study? Dr. Tang: A chemical byproduct of gut bacteria-dependent digestion, TMAO (trimethylamine N-oxide), was previously shown to contribute to heart disease development. In this study, blood levels of TMAO for the first time are linked to heart failure development and mortality risk. (more…)
Author Interviews, Heart Disease / 16.09.2014

Muthiah Vaduganathan, MD MPH Department of Medicine Massachusetts General Hospital Boston, MassMedicalResearch.com Interview with: Muthiah Vaduganathan, MD MPH Department of Medicine Massachusetts General Hospital Boston, Mass Medical Research: What are the main findings of the study? Dr. Vaduganathan: Based on data from a large, multinational randomized controlled trial of patients hospitalized for heart failure and reduced ejection fraction (HFrEF), we conducted a retrospective analyses of the clinical profiles associated with baseline serum uric acid levels. Serum uric acid was commonly elevated in patients hospitalized for heart failure and reduced ejection fraction (mean ~9 mg/dL), especially in men and black patients. Higher uric acid levels were associated with lower systolic blood pressure and EF, higher natriuretic peptides, and more impaired renal function. After accounting for 24 known baseline covariates, serum uric acid was independently predictive of post-discharge mortality and rehospitalization in patients with relatively preserved renal function, but not in those with poor renal function. (more…)
Author Interviews, Diabetes, Diabetes Care, Heart Disease / 12.09.2014

Kristian Filion, PhD FAHA Assistant Professor of Medicine Division of Clinical Epidemiology Jewish General Hospital/McGill University Montreal, Quebec H3T 1E2 CanadaMedicalResearch.com Interview with: Kristian Filion, PhD FAHA Assistant Professor of Medicine Division of Clinical Epidemiology Jewish General Hospital/McGill University Montreal, Quebec H3T 1E2 Canada Medical Research: What are the main findings of the study? Dr. Filion: Previous studies have raised concerns that the use of incretin-based drugs, a type of medication used to treat diabetes, may increase the risk of congestive heart failure.  We therefore examined this potential drug safety issue using a large, population-based database, which allowed us to study the safety of these medications in a real world setting.  In doing so, we found that the use of incretin-based drugs was not associated with an increased risk of congestive heart failure among patients with type 2 diabetes.  Similar results were obtained among both classes of incretin-based drugs (glucagon like peptide-1 [GLP-1] analogs and dipeptidyl peptidase-4 [DPP-4] inhibitors), and no duration-response relationship was observed. (more…)
Author Interviews, Heart Disease, NEJM / 30.08.2014

MedicalResearch.com Interview with: John J.V. McMurray, M.D Professor of Medical Cardiology British Heart Foundation, Cardiovascular Research Centre University of Glasgow, Glasgow, United Kingdom MedicalResearch.com Interview with: John J.V. McMurray, M.D Professor of Medical Cardiology British Heart Foundation, Cardiovascular Research Centre University of Glasgow, Glasgow, United Kingdom Medical Research: What are the main findings of the study? Dr. McMurray: That compared to an evidence-based dose of an evidence-based ACE inhibitor (enalapril 10 mg bid), LCZ696 reduced the primary composite outcome of cardiovascular death or heart failure hospitalization by 20%, both the components of that composite and all-cause mortality (the latter by 16%) - all reductions are highly statistically significant and clinically important. LCZ696 treated patients also reported fewer symptoms and physical limitations due to heart failure. We think this is a remarkable finding - to beat what has been the gold-standard, cornerstone, therapy for around 25 years. The findings show conclusively that adding neprilysin inhibition to renin-angiotensin system blockade is superior to renin-angiotensin system blockade alone in patients with heart failure and reduced ejection fraction . (more…)
AHA Journals, Author Interviews, Heart Disease, Red Meat / 17.07.2014

MedicalResearch.com Interview with: Dr inz. Joanna Kaluza Department of Human Nutrition Warsaw University of Life Sciences - SGGW Warsaw POLAND Medical Research: What are the main findings of the study? Response: The most important finding of my study is the fact that processed red meat consumption, but not unprocessed red meat, increases a risk of Heart Failure incidence and Heart Failure mortality. (more…)
Author Interviews, BMJ, Heart Disease / 04.07.2014

MedicalResearch.com Interview with: Dr. Patrícia Lourenço Serviço de Medicina Interna, Centro Hospitalar São João Faculdade de Medicina da Universidade do Porto, Unidade I&D Cardiovascular do Porto Monteiro, Portugal; Medical Research: What are the main findings of the study? Dr. Lourenço: A low prealbumin at hospital discharge associates with morbidity and mortality in acute heart failure patients. The prognostic value of low prealbumin in heart failure is independent of other nutritional markers and of the inflammatory status. (more…)
Annals Internal Medicine, General Medicine, Hospital Readmissions / 04.06.2014

Cindy Feltner, MD, MPH Assistant Professor, Division of General Medicine University of North Carolina--Chapel Hill RTI- UNC Evidence-based Practice CenterMedicalResearch.com Interview with: Cindy Feltner, MD, MPH Assistant Professor, Division of General Medicine University of North Carolina--Chapel Hill RTI- UNC Evidence-based Practice Center MedicalResearch: What are the main findings of the study? Dr. Feltner: We conducted a systematic review and meta-analysis to assess the efficacy, comparative effectiveness, and harms of transitional care interventions to reduce readmission and mortality rates for adults hospitalized with heart failure. We included a broad range of intervention types applicable to adults transitioning from hospital to home that aimed to prevent readmissions. Although 30-day readmissions are the focus of quality measures, we also included readmissions measured over 3 to 6 months because these are common, costly, and potentially preventable. Forty-seven trials were included, most enrolled adults with moderate to severe heart failure and a mean age of 70 years. We found that interventions providing multiple home visits soon after hospital discharge can reduce 30-day readmission rates. Both home-visiting programs and multidisciplinary heart failure clinics visits can improve mortality and reduce all-cause readmission in the six months after hospitalization. Telephone support interventions do not appear to reduce all-cause readmission, but can improve survival and reduce readmission related to heart failure. Programs focused on telemonitoring or providing education only did not appear to reduce readmission or improve survival. (more…)
Author Interviews, Heart Disease, JAMA / 03.06.2014

MedicalResearch.com Interview with: Sana Al-Khatib, M.D. MHS Duke Clinical Research Institute Duke University School of Medicine Durham, NC,MedicalResearch.com Interview with: Sana Al-Khatib, M.D. MHS Duke Clinical Research Institute Duke University School of Medicine Durham, NC, MedicalResearch: What are the main findings of the study? Dr. Al-Khatib: Patients with an ejection fraction (measure of the pumping ability of the heart) of 30% to 35% who receive a prophylactic implantable cardioverter defibrillator have better survival than similar patients with no implantable defibrillator. (more…)
Author Interviews, Diabetes, Diabetologia, Heart Disease / 22.05.2014

MedicalResearch.com Interview with: Malene Nøhr Demant Department of Cardiology Copenhagen University Hospital Gentofte Hellerup, Denmark MedicalResearch: What are the main findings of the study? Dr. Demant: Our study shows that increasing severity of heart failure is associated with an increased risk of developing diabetes. Increasing loop-diuretic dosage was used as a proxy for heart failure severity. Patients with the most severe heart failure were three times more likely to develop diabetes than those with the least severe. Patients who were also being treated with ACE inhibitors (angiotensin-converting-enzyme inhibitors) had a less pronounced increase in diabetes risk. Patients who developed diabetes were 16% more likely to die than those who did not develop diabetes. (more…)
Author Interviews, Heart Disease, NEJM / 11.04.2014

Marc A. Pfeffer, M.D., Ph.D. Dzau Professor of Medicine Harvard Medical School Cardiovascular Division Brigham and Women's HospitalMedicalResearch.com Interview with: Marc A. Pfeffer, M.D., Ph.D. Dzau Professor of Medicine Harvard Medical School Cardiovascular Division Brigham and Women's Hospital MedicalResearch.com: What are the main findings of the study? Dr. Pfeffer: We randomized 3445 patients with symptomatic heart failure and a left ventricular ejection fraction greater than or equal to 45% (heart failure with preserved ejection fraction or diastolic heart failure) to spironolactone or placebo and followed them for over 3 years. Our primary outcome the composite of death from cardiovascular causes, aborted cardiac arrest, or hospitalization for management of heart failure was not significantly reduced in the group randomized to spironolactone. We did, however, observe that fewer patients in the spironolactone group were hospitalized for the management of heart failure following randomization. Spironolactone therapy was associated with higher incidence of  hyperkalemia and rises in serum creatinine. (more…)
Author Interviews, Heart Disease, Hospital Readmissions, JACC, Outcomes & Safety / 18.10.2013

Saul Blecker, MD, MHS Department of Population Health, NYU School of Medicine, New York, NY Department of Medicine, NYU School of Medicine, New York, NYMedicalResearch.com Interview with: Saul Blecker, MD, MHS Department of Population Health, NYU School of Medicine Department of Medicine, NYU School of Medicine, New York, NY   MedicalResearch.com: What are the main findings of the study? Dr. Blecker: Inpatient quality of care has focused primarily on patients with acute heart failure, commonly identified by principal discharge diagnosis code. However, patients with heart failure are commonly hospitalized for other causes and should benefit from many of the same treatments. We found that in our sample, as compared to patients with a principal diagnosis of heart failure, heart failure patients hospitalized with a non–heart failure diagnosis had lower rates of guideline-concordant care, including assessment of left ventricular function and prescription for an ACE inhibitor or ARB, at time of discharge. This is important as our study suggests that these therapies were associated with reduced mortality for patients hospitalized with heart failure, regardless of the reason for hospitalization. (more…)
Author Interviews, Environmental Risks, Heart Disease / 22.09.2013

MedicalResearch.com Interview with: Dr Anoop Shah MBChB Cardiology Research fellow Centre of Cardiovascular sciences Chancellors Building University Of Edinburgh Little France Edinburgh MedicalResearch.com: What are the main findings of the study? Answer: Many studies have shown the effect of air pollution on cardiac mortality and myocardial infarction. Less studies have shown a similar effect on patients with heart failure. We therefore systemically reviewed and pooled data across 12 countries involving over 4 million patients with heart failure. We showed that air pollution has a close temporal association with either being hospitalized or dying from heart failure. Most of the effects of air pollution on patients with heart failure were acute. Most of the data that we analyzed came from developed countries across Europe and the USA. There was a  significant paucity of data from rapidly urbanizing nations such as India and China. (more…)
Author Interviews, Cost of Health Care, Heart Disease, Outcomes & Safety / 20.08.2013

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). (more…)