Followup with community doctor critical for heart failure patients after hospital stay: UAlberta medical research

Heart failure patients more likely to survive or avoid readmission if they see a doctor within 30 days of leaving hospital

Raquel Maurier - 19 August 2013

New evidence from the University of Alberta shows just how crucial the patient-doctor relationship can be for people who have suffered heart failure.

Heart failure patients who follow up with a doctor within the first month of leaving hospital are more than 10 per cent less likely to die or require emergency re-hospitalizations compared to those who don't see a doctor in that timeframe, demonstrates recently published medical research from the University of Alberta. And if that visit is with a doctor who has seen the patient before, the patient's odds of staying healthy in that critical first month at home are even better.

Faculty of Medicine & Dentistry researcher Finlay McAlister published his findings in the peer-reviewed journal, Canadian Medical Association Journal, today. He is a researcher in the Department of Medicine, a Research Chair in Cardiovascular Outcomes, Alberta Innovates - Health Solutions Senior Health Scholar, and a physician at the heart failure clinic in Edmonton.

"I think the perception of patients, their families and health-care providers, is that once someone is released from the hospital, they are stable. There isn't enough appreciation that the transition from hospital back to the community is a fairly high-risk situation for heart failure patients," says McAlister.

"Heart failure is the number one cause of hospitalization for adults over 65. And heart failure has one of the highest readmission rates and mortality rates 30 days after discharge from hospital. We need to do more to ensure followup visits with community physicians happen shortly after these patients leave the hospital."

McAlister noted educating patients and their families about this high-risk time is important, as is the need for hospital and community physicians to communicate with one another about their heart failure patients. Physicians do use "prediction models" to try to pinpoint those most at risk for complications after release from hospital, but those models aren't perfect and only identify about 60 per cent of the patients who do have problems at home, says McAlister.

"I hope this research will inspire hospital physicians and primary care physicians to examine our clinical practice. For example, could community physicians have urgent clinic slots available for patients who have just been discharged from the hospital? Could hospital physicians ensure that arrangements for the followup visit with a doctor in the community have been made prior to discharge? If that isn't possible, could the hospital physician see the patient after discharge to ensure the transition back to the community has been successful?"

"Often, by the end of their hospital stay, people with heart failure are stable because we are regulating how much fluid they take, how much salt they get in their food, how much they exert, etc. But when they go home, their diet and activity levels change, so medication doses that were appropriate in the hospital may no longer be appropriate at home, and the medications may need adjusting."

The study looked at more than 24,000 adult heart failure patients in Alberta who were discharged from hospital between January 1999 and June 2009. About 20 per cent of those patients died or required hospital readmission within the first month after discharge. Almost 22 per cent of the patients didn't follow up with physicians within the first 30 days of release from hospital, while 69 per cent saw physicians they knew, and nine per cent saw unfamiliar physicians. Those patients who saw physicians within the first month were more than 10 per cent less likely to die or require readmission when compared to those who did not.

The Canadian Institutes of Health Research funded the original study that produced the data used in this research. McAlister's faculty collaborators included Erik Youngson, Jeffrey Bakal, Padma Kaul, and Justin Ezekowitz, as well as University of Ottawa colleague Carl van Walraven.