Abstract 13086: National Trends in Timely Ambulatory Follow-Up After Acute Myocardial Infarction and Congestive Heart Failure Cospitalizations Among Medicare Beneficiaries

Abstract

Introduction: Following hospitalization for acute myocardial infarction (AMI) or congestive heart failure (CHF), close outpatient follow-up is warranted for symptom monitoring and initiation or titration of evidence-based therapies. Objective: To describe temporal trends in ambulatory care following CHF and AMI hospitalizations, between 2010 and 2019. Methods: We examined a 100% sample of Medicare fee-for-service beneficiaries discharged to the community after an AMI or CHF hospitalization. We assessed quarterly rates of timely post-discharge cardiology and primary care follow-up, defined as receipt of an ambulatory visit within 14 days of discharge. We assessed trends for five subgroups based upon known disparities in cardiovascular outcomes: sex, race/ethnicity, Medicaid dual-eligibility, county-level social deprivation index, and rurality. Results: The AMI cohort included 1,680,916 hospitalizations (54.9% male, 9.4% Black, 81.7% White) and the CHF cohort included 4,256,405 hospitalizations (47.7% male, 16.2% Black, 75.0% White). Timely cardiology follow-up after AMI increased from 26.8% in 2010 to 39.4% in 2019 (absolute change 12.6%) while follow-up after CHF increased from 22.0% to 33.4% (absolute change 11.5%). The proportion of patients without cardiology or primary care follow-up after AMI decreased to 36.1% in 2019 and to 41.6% for CHF. Though rates of timely follow-up increased for all demographic groups, female, Black, Hispanic, Medicaid dual-eligible patients, patients residing in rural areas, and patients residing in counties with high social deprivation were less likely to receive follow-up throughout the study. Conclusions: Rates of timely ambulatory care after AMI and CHF hospitalization have improved, but the majority of patients do not receive follow-up within 14 days of discharge. Efforts to improve post-hospital cardiology and primary care follow-up have the potential to improve clinical outcomes and reduce disparities.