130 Meeting established canadian benchmarks for access to heart failure (HF) care following emergency department visit and association with outcome

Abstract

BackgroundPrompt access to care that optimizes outcomes is crucial in the management of heart failure (HF). The Canadian Cardiology Society (CCS) recommends that patients should be seen within two weeks following an emergency department (ED) visit for HF. However, it is unknown whether lack of adherence to this benchmark translates into worse clinical outcomes.ObjectiveThe objective was to examine whether delay in consultation following an ED visit for HF was related to adverse outcomes/events (death, hospitalization or repeat ED visit).MethodsPatients with a confirmed diagnosis of HF were recruited by nurses at 8 hospital EDs in Québec, Canada. They were interviewed by telephone within 6 weeks of ED discharge and subsequently at 3 months and 6 months. They responded to questions related to use of health services, sociodemographic information, the Minnesota Living with Heart Failure Questionnaire, and the Stanford Self-Efficacy in Chronic Disease Questionnaire. Pertinent clinical variables were extracted from medical charts by trained nurses. We used Cox regression to analyze whether delayed medical follow-up following ED visit was associated with increased risk of adverse events independently of other clinical covariates.ResultsWe recruited a total of 551 patients. The mean age was 75.5 ± 11.0 years and 51% were males. Only 30% consulted with a physician for their HF within 2 weeks post ED visit. By 4 weeks, 51% consulted a physician. Over the 6 month follow-up, 25% returned to the ED, 23% were hospitalized, and 13.6% died. Patients who consulted a physician within 2 weeks of ED discharge had a non-significantly lower risk of adverse events (HR: 0.69, 95% CI 0.40-1.2). However, by 4 weeks, this relationship became statistically significant: patients who consulted a physician for their HF within 4 weeks were less likely to sustain an adverse event (HR: 0.59, 95% CI 0.36-0.97). In addition to late clinical follow up, factors associated with a higher risk of adverse event included worse Minnesota Score, HF with systolic dysfunction and previous myocardial infarction.ConclusionPrompt follow-up post ED visit for HF is associated with lower risk for major adverse event. Adherence to current CCS benchmarks is crucial. There is an urgent need to improve the rate of medical consultation within 2 to 4 weeks following ED visit for patients with HF.Canadian Institutes of Health Research (CIHR) BackgroundPrompt access to care that optimizes outcomes is crucial in the management of heart failure (HF). The Canadian Cardiology Society (CCS) recommends that patients should be seen within two weeks following an emergency department (ED) visit for HF. However, it is unknown whether lack of adherence to this benchmark translates into worse clinical outcomes. Prompt access to care that optimizes outcomes is crucial in the management of heart failure (HF). The Canadian Cardiology Society (CCS) recommends that patients should be seen within two weeks following an emergency department (ED) visit for HF. However, it is unknown whether lack of adherence to this benchmark translates into worse clinical outcomes. ObjectiveThe objective was to examine whether delay in consultation following an ED visit for HF was related to adverse outcomes/events (death, hospitalization or repeat ED visit). The objective was to examine whether delay in consultation following an ED visit for HF was related to adverse outcomes/events (death, hospitalization or repeat ED visit). MethodsPatients with a confirmed diagnosis of HF were recruited by nurses at 8 hospital EDs in Québec, Canada. They were interviewed by telephone within 6 weeks of ED discharge and subsequently at 3 months and 6 months. They responded to questions related to use of health services, sociodemographic information, the Minnesota Living with Heart Failure Questionnaire, and the Stanford Self-Efficacy in Chronic Disease Questionnaire. Pertinent clinical variables were extracted from medical charts by trained nurses. We used Cox regression to analyze whether delayed medical follow-up following ED visit was associated with increased risk of adverse events independently of other clinical covariates. Patients with a confirmed diagnosis of HF were recruited by nurses at 8 hospital EDs in Québec, Canada. They were interviewed by telephone within 6 weeks of ED discharge and subsequently at 3 months and 6 months. They responded to questions related to use of health services, sociodemographic information, the Minnesota Living with Heart Failure Questionnaire, and the Stanford Self-Efficacy in Chronic Disease Questionnaire. Pertinent clinical variables were extracted from medical charts by trained nurses. We used Cox regression to analyze whether delayed medical follow-up following ED visit was associated with increased risk of adverse events independently of other clinical covariates. ResultsWe recruited a total of 551 patients. The mean age was 75.5 ± 11.0 years and 51% were males. Only 30% consulted with a physician for their HF within 2 weeks post ED visit. By 4 weeks, 51% consulted a physician. Over the 6 month follow-up, 25% returned to the ED, 23% were hospitalized, and 13.6% died. Patients who consulted a physician within 2 weeks of ED discharge had a non-significantly lower risk of adverse events (HR: 0.69, 95% CI 0.40-1.2). However, by 4 weeks, this relationship became statistically significant: patients who consulted a physician for their HF within 4 weeks were less likely to sustain an adverse event (HR: 0.59, 95% CI 0.36-0.97). In addition to late clinical follow up, factors associated with a higher risk of adverse event included worse Minnesota Score, HF with systolic dysfunction and previous myocardial infarction. We recruited a total of 551 patients. The mean age was 75.5 ± 11.0 years and 51% were males. Only 30% consulted with a physician for their HF within 2 weeks post ED visit. By 4 weeks, 51% consulted a physician. Over the 6 month follow-up, 25% returned to the ED, 23% were hospitalized, and 13.6% died. Patients who consulted a physician within 2 weeks of ED discharge had a non-significantly lower risk of adverse events (HR: 0.69, 95% CI 0.40-1.2). However, by 4 weeks, this relationship became statistically significant: patients who consulted a physician for their HF within 4 weeks were less likely to sustain an adverse event (HR: 0.59, 95% CI 0.36-0.97). In addition to late clinical follow up, factors associated with a higher risk of adverse event included worse Minnesota Score, HF with systolic dysfunction and previous myocardial infarction. ConclusionPrompt follow-up post ED visit for HF is associated with lower risk for major adverse event. Adherence to current CCS benchmarks is crucial. There is an urgent need to improve the rate of medical consultation within 2 to 4 weeks following ED visit for patients with HF.Canadian Institutes of Health Research (CIHR) Prompt follow-up post ED visit for HF is associated with lower risk for major adverse event. Adherence to current CCS benchmarks is crucial. There is an urgent need to improve the rate of medical consultation within 2 to 4 weeks following ED visit for patients with HF.