Factors Associated with Adherence to 14-Day Office Appointments after Heart Failure Discharge

Abstract

A follow-up office visit within 7-14 days after discharge for heart failure (HF) is a guideline-recommended intervention to reduce 30-day hospital readmission, but visit adherence varies. The purpose of this study was to determine predictors of adherence to an early follow-up appointment after a HF hospitalization. Hypothesis: In patients with HF, missed early follow-up appointments after hospital discharge can be predicted by a model of patient factors (age, gender, race, insurance, marital status, contact person, distance home to clinic, smoking, alcohol abuse, drug use, and comorbidities), HF factors(LVEF, time since previous admission, HF type, and number of HFspecific medications prescribed), and hospital factors (length of stay, ICU admission and LOS, admission source, discharge disposition, provider type, and appointment made pre-or post-discharge). Methods: This was a retrospective, medical record/administrative database research design within 3 community hospitals of a large health system in Northeast Ohio. All patients hospitalized for decompensated HF and scheduled for an early follow-up visit within 14 days of discharge were included. Sample size was determined based on having at least 10 non-adherent and adherent cases for each factor in a multivariate model. Data were retrieved using eMR or administrative record queries and manual review. MapQuest was used to calculate distance in miles from patients' home addresses to the clinic. Subjects were categorized into groups of visit-kept and visit-missed. Factors were assessed for their association with missed appointments using Pearson chi-square tests and Wilcoxon rank sum tests. Multivariable modeling was used to determine the odds of missing scheduled appointments. Results: Of 701 subjects, mean (SD) age was 73.5(13.8) years, 46.4% were female and 38.9% were non-white. Appointment adherence was 83.7% (587 visit-kept and 114 visit-missed). In multivariate analyses, 4 of 36 factors predicted missed appointments: drug use history (OR 3.95 [

Thirty‐day readmissions after transcatheter versus surgical mitral valve repair in high‐risk patients with mitral regurgitation: Analysis of the 2014–2015 Nationwide readmissions databases

“…Furthermore, recent data from the American Heart Association's Get With The Guidelines Heart Failure Registry and other investigations have shown history of anemia to play a role in heart failure decompensation and ultimately leading to 30‐day readmission among patients with heart failure . Community based research has shown an association between anemia and missed outpatient follow‐up appointments in patients hospitalized for decompensated heart failure, thus making them more likely to be readmitted . Prior studies have shown that the Elixhauser comorbidity variable “fluid and electrolyte disorder” is significantly associated with an increased risk of all cause 30‐day readmission among patients 65 years and older .…”

Examining the Association between Emotional Dysregulation and Treatment Burden

“…Based on our findings, patients experience higher levels of emotional dysregulation and associated treatment burden when interfacing with the healthcare system (e.g., lab testing, scheduling/waiting at provider appointments), performing self-management tasks (e.g., monitoring blood sugars), within their social relationships (e.g., feeling like a burden to others), and the burden of constantly needing care due to their conditions as compared to specific medication, exercise, and dietary related burden. These associations suggest that patients are at risk for lower adherence from the burden of attending provider appointments (Distelhorst et al, 2018; Horstmann et al, 2010; Schectman et al, 2008), poor self-monitoring (Crowe et al, 2017; Henderson et al, 2014; Tucker et al, 2017), and strained social relationships (Gallant, 2003; Meek et al, 2018), all of which can lead to worsening health outcomes. Indirectly, these associations could contribute to a feeling of greater total treatment burden further decreasing adherence to other critical self-management (e.g., medication, exercise, and diet) tasks (Schreiner et al, 2020a).…”