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08-08-2011 | Cardiology | Article

Follow-up after HF hospitalization linked to physician density, patient factors


Free abstract

MedWire News: Early physician follow-up after heart failure (HF) hospitalization is associated with physician density, geographic location, socioeconomic status, gender, race, and comorbidity, US researchers say.

Patients who are hospitalized for HF are at high risk for post-discharge re-admission or death, explain Robb Kociol (Duke University School of Medicine, Durham, North Carolina) and co-authors in the American Journal of Cardiology. Early physician follow-up, defined by the American College of Cardiology as occurring within 7 days of discharge, is therefore recommended to decrease the risk for re-admission.

However, despite evidence supporting the 7-day cutoff for reducing 30-day re-admission rates in HF patients, many patients do not receive it, the authors say.

"Whether physician density or other associated factors affect access to early physician follow-up in recent discharged patients with HF is not well understood."

The authors therefore investigated patient characteristics of 30,136 participants in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF) and Get With The Guidelines-Heart Failure (GWTG-HF) registries, who were discharged after HF hospitalization between January 2003 and December 2006. These clinical data were linked with Medicare inpatient claims data over the same period.

Overall, 11,420 patients (37.9%) had an early physician follow-up.

After dividing the patients into quartiles according to the number of physicians per 100,000 residents in a hospital referral region, those who lived in a hospital referral region with the highest number of physicians (Q4; 211-320) were 29% more likely to have an early follow-up than those who lived in a region with the lowest number (Q4; 116-175).

Patients who lived in a rural area were 16% less likely to have an early follow-up than those who lived in nonrural areas (p<0.001).

In addition, patients of lower socioeconomic status, defined as those who used State Medicaid buy-in, were 21% less likely to have an early follow-up than those who did not use a Medicaid buy-in.

Multivariate analysis revealed that compared with men, women were 13% less likely to have an early follow-up, and Black patients were 16% less likely to have an early follow-up than patients of other races.

Furthermore, patients who had comorbidities, including left ventricular dysfunction, chronic obstructive pulmonary disease, or chronic renal insufficiency also had a significantly lower chance of an early follow-up (odds ratios=0.91, 0.94, 0.89, respectively, p ≤0.02), than patients without these comorbidities.

"Strategies are needed to ensure access among vulnerable populations to this supply-sensitive resource," conclude the authors.

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Piriya Mahendra

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