Objectives: The goal of this study was to evaluate the effect of physician continuity for patients with heart failure (HF) treated and released from the emergency department (ED).
Background: Although current guidelines recommend early follow-up after hospital discharge, it is unclear if it is beneficial in patients sent home from the ED and whether this follow-up should be with a familiar physician.
Methods: This was a retrospective cohort of all adults treated and released from 93 EDs in Alberta, Canada, from 1999 to 2009 with a first-time most responsible diagnosis of HF. Cox proportional hazards models with time-varying covariates for post-ED outpatient visits were used.
Results: In 12,285 patients (mean age 74.9 years), the rate of death or all-cause hospitalization at 6 months was lower in those who saw a familiar physician (37.3%; adjusted hazard ratio [aHR]: 0.89 [95% confidence interval (CI): 0.83 to 0.96]) in the first month versus those with no outpatient visits (58.1%; aHR: 1.00 [referent]) or visits only with unfamiliar physicians (40.2%; aHR: 1.04 [95% CI: 0.94 to 1.15]). Taking into account all outpatient visits over each observation period and excluding those without follow-up, death or hospitalization was less common in those patients being followed up by a familiar physician (aHR of 0.79 [95% CI: 0.71 to 0.89] at 3 months; aHR of 0.86 [95% CI: 0.77 to 0.95] at 6 months; and aHR of 0.87 [95% CI: 0.80 to 0.96] at 12 months compared with unfamiliar physician follow-up). Any follow-up within 30 days of ED release was associated with a lower risk of repeat ED visit or death at 6 months (aHR: 0.78 [95% CI: 0.73 to 0.82] for familiar physicians; aHR: 0.79 [95% CI: 0.72 to 0.86] for unfamiliar physicians).
Conclusions: Early follow-up after an ED visit is associated with better outcomes, particularly if conducted with a familiar physician.
Keywords: emergency department; follow-up; heart failure.
Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.