Patients with heart failure have lower risk of death, hospital admission if seen by physician in first 7 days after emergency department discharge

For patients who receive emergency department care for heart failure, early follow-up by a physician within 7 days after emergency department discharge is associated with lower rates of death or admissions to hospital, according to research published in CMAJ (Canadian Medical Association Journal).

However, the researchers found that less than half of the 34 519 patients in the study were seen by a physician within 7 days of discharge from the emergency department.

"Unlike patients admitted to hospital, patients discharged from the emergency department do not receive daily assessment and investigations by physicians and nurses," writes Dr. Clare Atzema, ICES, with coauthors. "These patients are left to arrange their own subsequent care."

In Canada, the direct cost of heart failure is $2.8 billion a year. There are more than a million visits to the emergency department for heart failure in North America annually. As hospital admissions are the costliest aspect of care, systems are moving toward outpatient management when possible.

Of the total 34 519 patients with heart failure discharged from the emergency department in the present study, 47% (16 274) saw a physician within a week, and 83.6% (28 846) received care within 30 days. Almost one-quarter (23.5%) of patients died within a year of their emergency department visit, with the lowest death rate (21.7%, 3533 patients) in those seen within 7 days.

"Given our findings, we argue that scheduled follow-up appointments for patients with heart failure in the emergency department should be prioritized," state the authors. "The most efficient way to do this is to provide an appointment before they leave the emergency department."

The authors note that many patients are seen when doctors' offices are closed but that linking hospital and outpatient records electronically could help schedule appointments.

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"Effect of early physician follow-up on mortality and subsequent hospital admissions after emergency care for heart failure: a retrospective cohort study" is published December 17, 2018.