Timing Is Everything: Outpatient Follow-Up Between One And Two Weeks Post-Admission For Heart Failure Is Associated With The Lowest Rate Of Readmission Before 30 Days.

Abstract

Introduction Hospital readmission following hospitalization for heart failure (CHF) is common and challenging to prevent. Get With The Guidelines performance measures include follow-up (F/U) within 7 days, which is logistically challenging. Optimized timing of F/U may both reduce rehospitalizations and burden on providers/systems. Hypothesis There is no difference in 30-day hospital readmission rates between patients who F/U within 1-7 days vs. F/U within 8-14 days. Both intervals will have lower readmission rates than those who had no F/U within the first 30 days. Methods We retrospectively reviewed a cohort of patients discharged alive after admission for CHF between January 1, 2010 and March 13, 2021 and who had available F/U data. We examined the association between all-cause 30-day readmission type (cardiology vs. general) and timing of F/U appointment [0-7 (1W); 8-14 (2W); 15-30 days (1MO); 30-day or longer F/U (LATE)]. We used generalized estimating equations survival-time analysis models to account for clustering. We performed a subgroup analysis of admissions since 2015 controlling for risk of 30-day readmission using a prediction score previously developed using machine learning of demographic and clinical data. Results Among 15,766 admissions of 10,523 patients, the 30-day readmission rates were 19.2%, 18.8%, 20.7%, and 23.7% for 1W, 2W, 1MO and LATE respectively, with an overall rate of 21.1%. There was no difference in odds of readmission between 1W and 2W (OR 0.96; 95%CI 0.85-1.09; p=0.530). F/U at either 1W or 2W had lower odds of readmission compared to LATE (OR 0.79; 95%CI 0.73-0.87; p<0.001; Figure 1) and there was a nonsignificant trend toward lower odds of readmission among those with cardiologist F/U as compared to general medicine (OR 0.91; 95%CI 0.82-1.00; P=0.053). In the subgroup analysis comprising 5,853 admissions with 30-day readmission prediction score, the odds of readmission were lower for 2W compared to 1W (OR 0.81; 95%CI 0.66-0.99; p= 0.048). F/U at either 1W or 2W had lower odds of readmission compared to LATE (OR 0.84; 95%CI 0.73-0.98; p=0.026). Conclusions After discharge for CHF hospitalization, outpatient follow-up between 8 and 14 days may be the optimal timeframe for reducing the rate of readmission at 30 days within at least one health system. Hospital readmission following hospitalization for heart failure (CHF) is common and challenging to prevent. Get With The Guidelines performance measures include follow-up (F/U) within 7 days, which is logistically challenging. Optimized timing of F/U may both reduce rehospitalizations and burden on providers/systems. There is no difference in 30-day hospital readmission rates between patients who F/U within 1-7 days vs. F/U within 8-14 days. Both intervals will have lower readmission rates than those who had no F/U within the first 30 days. We retrospectively reviewed a cohort of patients discharged alive after admission for CHF between January 1, 2010 and March 13, 2021 and who had available F/U data. We examined the association between all-cause 30-day readmission type (cardiology vs. general) and timing of F/U appointment [0-7 (1W); 8-14 (2W); 15-30 days (1MO); 30-day or longer F/U (LATE)]. We used generalized estimating equations survival-time analysis models to account for clustering. We performed a subgroup analysis of admissions since 2015 controlling for risk of 30-day readmission using a prediction score previously developed using machine learning of demographic and clinical data. Among 15,766 admissions of 10,523 patients, the 30-day readmission rates were 19.2%, 18.8%, 20.7%, and 23.7% for 1W, 2W, 1MO and LATE respectively, with an overall rate of 21.1%. There was no difference in odds of readmission between 1W and 2W (OR 0.96; 95%CI 0.85-1.09; p=0.530). F/U at either 1W or 2W had lower odds of readmission compared to LATE (OR 0.79; 95%CI 0.73-0.87; p<0.001; Figure 1) and there was a nonsignificant trend toward lower odds of readmission among those with cardiologist F/U as compared to general medicine (OR 0.91; 95%CI 0.82-1.00; P=0.053). In the subgroup analysis comprising 5,853 admissions with 30-day readmission prediction score, the odds of readmission were lower for 2W compared to 1W (OR 0.81; 95%CI 0.66-0.99; p= 0.048). F/U at either 1W or 2W had lower odds of readmission compared to LATE (OR 0.84; 95%CI 0.73-0.98; p=0.026). After discharge for CHF hospitalization, outpatient follow-up between 8 and 14 days may be the optimal timeframe for reducing the rate of readmission at 30 days within at least one health system.