Abstract 166: Ideal Timeframe for Post-Discharge Follow-Up Appointment in ACS and CHF BRIDGE Patients

Abstract

Background: Current research and guidelines vary greatly on the ideal time for initial post-discharge follow-up for acute coronary syndrome (ACS) and congestive heart failure (CHF). BRIDGE is a nurse practitioner-delivered cardiac transitional care program for patients lacking primary care or cardiology follow-up at discharge. BRIDGE referrals are seen within 14 days of discharge. This study aimed to determine the ideal timeframe for initial post-discharge follow-up. Methods: Retrospective data from the BRIDGE registry were abstracted for ACS and CHF patients referred to BRIDGE and readmitted within 30 days. Patients were divided into 4 cohorts based on the number of days to readmission: Time (T)1=0-3 days, T2=4-7 days, T3=8-14 days, and T4=15-30 days. Readmissions were further classified as the same cardiac reason as index admission, “Different Cardiac” or “Non-Cardiac.” ACS and CHF readmissions were compared by time to readmission and reason for readmission . Results: Of 2367 patients (mean age 64.9, 58% male and 85.3% white), 733 patients had an admission for ACS and 548 for CHF. Regardless of BRIDGE attendance, 16.8% (n=123) of ACS patients and 25.4% (n= 139) of CHF patients and were readmitted within 30 days. The majority of readmissions within 30 days (ACS 62.6%, CHF 53.2%) were on or before the 14th day post-discharge. Nearly half of T1 readmissions (ACS=47.6%, CHF=55.6%) were for Non-Cardiac reasons. For all other timeframes, ACS patients had more readmissions for Different Cardiac reasons, and CHF patients more often were readmitted for CHF. In contrast to 30 day readmission rates for the entire population (16.8% and 25.4%), the 30-day readmission rate for ACS and CHF patients who attended their BRIDGE appointment was 6.4% and 15.4% respectively . Conclusions: For both CHF and ACS patients, greater than 50% of readmissions occurred before 14 days, with the majority of cardiac-related reasons occurring after the 3rd day post-discharge. Based on BRIDGE readmission rates, follow-up at 14 days substantially reduces 30-day readmissions in both ACS and CHF patients. However, seeing patients earlier or additionally during the 4-7 day period may further reduce 30-day readmissions.