New research shows heart failure patients who see a physician soon after their ED discharge have better overall outcomes. See what your ED group can do to help.
Is there a connection between early physician follow-up after an ED visit and better outcomes for heart failure patients?
Every year over a million people are admitted to the emergency department for heart failure, and that number is only rising[*].
But the one-year mortality rate for patients with heart failure discharged from an ED is 20%.
According to a study recently published in the Canadian Medical Association Journal (CMAJ), ED physicians may be able to increase the chance of survival for heart failure patients by simply helping them arrange follow-up care.
New Research Shows Heart Failure Patients Shouldn’t Be Discharged Until A Follow-Up Appointment With A Physician Is Scheduled
The researchers in that study wanted to learn whether early physician follow-up had any effect on mortality and hospital readmission numbers in patients admitted for heart failure.
So they analyzed data from adult patients with a heart failure diagnosis discharged from one of 163 EDs in Ontario, Canada, between April 2007 and March 2014.
Almost 25% of those heart failure patients died within a year of their emergency department visit.
But out of 34,519 patients[*]:
- 47.1% (16,274) obtained follow-up care within 7 days of their ED visit
- 83.6% (28,846) received follow-up care within 30 days
Though less than half of heart failure patients saw their physicians soon after their ED visit, those who received follow-up care within 7 days had:
- The lowest death rate over 1 year
- Fewer hospital re-admissions over 90 days and 1 year later
This means those who waited to schedule a follow-up had increased odds of mortality and expensive readmission visits.
Follow-up care within 30 days was still associated with a reduction in 1-year mortality compared to those who never sought post-ED care, however, there was an increase in 90-day admissions to the hospital.
Hospital admissions for heart failure patients account for the largest expense when it comes to management and treatment.
Studies show the mean per-patient cost of a HF-related hospitalization totals around $14,000 for Medicare beneficiaries[*].
And in those studies, 22.3% of patients were readmitted within 30 days, 33.3% were readmitted within 60 days, and 40.2% were readmitted within 90 days, compounding costs further.
This is why researchers believe EM physicians should prioritize timely access to longitudinal care for patients with heart failure who are discharged from their independent ED group.
What Can Your Emergency Department Do To Reduce Heart Failure Mortality And Readmission Rates?
“Unlike patients admitted to [the] hospital, patients discharged from the emergency department do not receive daily assessment and investigations by physicians and nurses. These patients are left to arrange their own subsequent care.”
So before discharging a patient with heart failure, have your ED team:
Schedule a follow-up visit with the patient’s physician. Less than half of heart failure patients in the study obtained follow-up care within a week of their ED visit even though that window of time was associated with better outcomes.
Don’t leave scheduling a follow-up visit to your patients — have someone from your staff get in touch with their doctor to have a concrete appointment in place before discharge.
This may increase the likelihood of that patient receiving the care they need.
This will help increase the odds of survival for your heart failure patients, and hopefully prevent readmission.