Post-discharge Follow-up Characteristics Associated With 30-Day Readmission After Heart Failure Hospitalization

Abstract

Background: Readmission within 30 days after hospitalization for heart failure (HF) is a major public health problem.

Objective: To examine whether timing and type of post-discharge follow-up impacts risk of 30-day readmission in adults hospitalized for HF.

Design: Nested matched case-control study (January 1, 2006-June 30, 2013).

Setting: A large, integrated health care delivery system in Northern California.

Participants: Hospitalized adults with a primary diagnosis of HF discharged to home without hospice care.

Measurements: Outpatient visits and telephone calls with cardiology and general medicine providers in non-emergency department and non-urgent care settings were counted as follow-up care. Statistical adjustments were made for differences in patient sociodemographic and clinical characteristics, acute severity of illness, hospitalization characteristics, and post-discharge medication changes and laboratory testing.

Results: Among 11,985 eligible adults, early initial outpatient contact within 7 days after discharge was associated with lower odds of readmission [adjusted odds ratio (OR)=0.81; 95% CI, 0.70-0.94], whereas later outpatient contact between 8 and 30 days after hospital discharge was not significantly associated with readmission (adjusted OR=0.99; 95% CI, 0.82-1.19). Initial contact by telephone was associated with lower adjusted odds of 30-day readmission (adjusted OR=0.85; 95% CI, 0.69-1.06) but was not statistically significant.

Conclusions: In adults discharged to home after hospitalization for HF, outpatient follow-up with a cardiology or general medicine provider within 7 days was associated with a lower chance of 30-day readmission.

Figure 1

Unadjusted Risk of 30-Day Readmission by Post-Discharge Follow-up Contact