Author + information
- Received January 23, 2014
- Revision received February 28, 2014
- Accepted March 7, 2014
- Published online August 1, 2014.
- ∗Division of General Internal Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- †Patient Health Outcomes Research and Clinical Effectiveness Unit, University of Alberta, Edmonton, Alberta, Canada
- ‡Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
- ↵∗Reprint requests and correspondence:
Dr. Finlay A. McAlister, Division of General Internal Medicine, Faculty of Medicine and Dentistry, University of Alberta, 5-134C Clinical Sciences Building, 11350 83 Avenue, Edmonton, Alberta T6G 2G3, Canada.
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.
Dr. McAlister is supported by a salary award from Alberta Innovates–Health Solutions, and this evaluation was funded by the Canadian Institutes of Health Researchhttp://dx.doi.org/10.13039/501100000024 through a peer-reviewed operating grant. The funding agencies did not have input into study design, data collection, interpretation of results, or write-up/approval for submission. All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 23, 2014.
- Revision received February 28, 2014.
- Accepted March 7, 2014.
- American College of Cardiology Foundation