Risk of readmission and death after hospitalization for worsening heart failure: Role of post‐discharge follow‐up visits in a real‐world study from the Grand Est Region of France

Abstract

AimsPatients who experience hospitalizations due to heart failure (HF) face a significant risk of readmission and mortality. Our objective was to evaluate whether the risk of hospitalization and mortality following discharge from HF hospitalization differed based on adherence to the outpatient follow‐up (FU) protocol comprising an appointment with a general practitioner (GP) within 15 days, a cardiologist within 2 months or both (termed combined FU).Methods and resultsWe studied all adults admitted for a first HF hospitalization from 2016 to 2020 in France's Grand Est region. Association between adherence to outpatient FU and outcomes were assessed with time‐dependent survival analysis model. Among 67 476 admitted patients (mean age 80.3 ± 11.3 years, 53% women), 62 156 patients (92.2%) were discharged alive and followed for 723 (317–1276) days. Combined FU within 2 months was used in 21.1% of patients, with lower rates among >85 years, women, and those with higher comorbidity levels (p < 0.0001 for all). Combined FU was associated with a lower 1‐year death or rehospitalization (adjusted hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.88–0.94, p < 0.0001) mostly related to lower mortality (adjusted HR 0.65, 95% CI 0.62–0.68, p < 0.0001) whereas HF readmission was higher (adjusted HR 1.19, 95% CI 1.15–1.24, p < 0.0001). When analysing components of combined FU separately, 1‐year mortality was more related to cardiologist FU (HR 0.65, 95% CI 0.62–0.67, p < 0.0001), than GP FU (HR 0.87, 95% CI 0.85–0.90, p < 0.0001).ConclusionCombined FU is carried out in a minority of patients following HF hospitalization, yet it is linked to a substantial reduction in 1‐year mortality, albeit at the expense of an increase in HF hospitalizations.

Guideline‐directed medical therapy for heart failure: The key ingredient for successful in‐hospital and post‐discharge care

“…4 By comparison, accompanying data from GWTG-HF in 2021-2022 demonstrated that discharge rates of triple and quadruple guideline-directed medical therapy (GDMT) for HF with reduced ejection fraction (HFrEF) were only 31% and 9%, respectively. 5 In this issue of the Journal, Baudry et al 6 present a real-world observational analysis from the French Health Insurance Database examining the association between early post-discharge follow-up and subsequent rehospitalization and mortality. Patients hospitalized for HF for the first time between 2016 to 2020 in any department were included.…”