Access to heart failure care post emergency department visit: Do we meet established benchmarks and does it matter? - 26/04/13
, Thao Huynh, MD d, Julie Des Lauriers, MA b, c, Nadia Giannetti, MD d, Marc Frenette, MD e, François Grondin, MD f, Caroline Michel, MD g, Richard Sheppard, MD g, Martine Montigny, MD h, Serge Lepage, MD i, Viviane Nguyen, MD d, Hassan Behlouli, PhD d, Louise Pilote, MD, MPH, PhD dRésumé |
Background |
The Canadian Cardiology Society recommends that patients should be seen within 2 weeks after an emergency department (ED) visit for heart failure (HF). We sought to investigate whether patients who had an ED visit for HF subsequently consult a physician within the current established benchmark, to explore factors related to physician consultation, and to examine whether delay in consultation is associated with adverse events (AEs) (death, hospitalization, or repeat ED visit).
Methods |
Patients were recruited by nurses at 8 hospital EDs in Québec, Canada, and interviewed by telephone within 6weeks of discharge and subsequently at 3 and 6months. Clinical variables were extracted from medical charts by nurses. We used Cox regression in the analysis.
Results |
We enrolled 410 patients (mean age 74.9 ± 11.1years, 53% males) with a confirmed primary diagnosis of HF. Only 30% consulted with a physician within 2weeks post-ED visit. By 4weeks, 51% consulted a physician. Over the 6-month follow-up, 26% returned to the ED, 25% were hospitalized, and 9% died. Patients who were followed up within 4weeks were more likely to be older and have higher education and a worse quality of life. Patients who consulted a physician within 4weeks of ED discharge had a lower risk of AEs (hazard ratio 0.59, 95% CI 0.35-0.99).
Conclusion |
Prompt follow-up post-ED visit for HF is associated with lower risk for major AEs. Therefore, adherence to current HF guideline benchmarks for timely follow-up post-ED visit is crucial.
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Vol 165 - N° 5
P. 725-732 - mai 2013 Retour au numéro
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