Trends and Disparities in Ambulatory Follow-Up After Cardiovascular Hospitalizations : A Retrospective Cohort Study.

IF 19.6 1区医学 Q1 MEDICINE, GENERAL & INTERNAL Annals of Internal Medicine Pub Date : 2024-08-06 DOI:10.7326/M23-3475

Timothy S Anderson, Robert W Yeh, Shoshana J Herzig, Edward R Marcantonio, Laura A Hatfield, Jeffrey Souza, Bruce E Landon

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Abstract

Background: Timely follow-up after cardiovascular hospitalization is recommended to monitor recovery, titrate medications, and coordinate care.

Objective: To describe trends and disparities in follow-up after acute myocardial infarction (AMI) and heart failure (HF) hospitalizations.

Design: Retrospective cohort study.

Setting: Medicare.

Participants: Medicare fee-for-service beneficiaries hospitalized between 2010 and 2019.

Measurements: Receipt of a cardiology visit within 30 days of discharge. Multivariable logistic regression models were used to estimate changes over time overall and across 5 sociodemographic characteristics on the basis of known disparities in cardiovascular outcomes.

Results: The cohort included 1 678 088 AMI and 4 245 665 HF hospitalizations. Between 2010 and 2019, the rate of cardiology follow-up increased from 48.3% to 61.4% for AMI hospitalizations and from 35.2% to 48.3% for HF hospitalizations. For both conditions, follow-up rates increased for all subgroups, yet disparities worsened for Hispanic patients with AMI and patients with HF who were Asian, Black, Hispanic, Medicaid dual eligible, and residents of counties with higher levels of social deprivation. By 2019, the largest disparities were between Black and White patients (AMI, 51.9% vs. 59.8%, difference, 7.9 percentage points [pp] [95% CI, 6.8 to 9.0 pp]; HF, 39.8% vs. 48.7%, difference, 8.9 pp [CI, 8.2 to 9.7 pp]) and Medicaid dual-eligible and non-dual-eligible patients (AMI, 52.8% vs. 60.4%, difference, 7.6 pp [CI, 6.9 to 8.4 pp]; HF, 39.7% vs. 49.4%, difference, 9.6 pp [CI, 9.2 to 10.1 pp]). Differences between hospitals explained 7.3 pp [CI, 6.7 to 7.9 pp] of the variation in follow-up for AMI and 7.7 pp [CI, 7.2 to 8.1 pp]) for HF.

Limitation: Generalizability to other payers.

Conclusion: Equity-informed policy and health system strategies are needed to further reduce gaps in follow-up care for patients with AMI and patients with HF.

Primary funding source: National Institute on Aging.

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心血管病住院后流动随访的趋势和差异：回顾性队列研究。

背景：心血管病住院后建议及时进行随访，以监测恢复情况：建议在心血管病住院后及时进行随访，以监测恢复情况、调整用药和协调护理：描述急性心肌梗死（AMI）和心力衰竭（HF）住院后随访的趋势和差异：设计：回顾性队列研究：医疗保险：2010年至2019年期间住院的医疗保险付费服务受益人：出院后30天内接受心脏病学检查。使用多变量逻辑回归模型，根据已知的心血管结果差异，估算总体和 5 个社会人口特征随时间的变化：队列中包括 1 678 088 例急性心肌梗死和 4 245 665 例高血压住院患者。2010 年至 2019 年期间，急性心肌梗死住院患者的心脏病学随访率从 48.3% 上升至 61.4%，高血压住院患者的心脏病学随访率从 35.2% 上升至 48.3%。就这两种情况而言，所有亚群的随访率都有所上升，但对于亚裔、黑人、西班牙裔、符合医疗补助双重资格的西班牙裔急性心肌梗死患者和高血压患者以及社会贫困程度较高的县居民而言，差距有所扩大。到 2019 年，黑人和白人患者之间的差距最大（AMI，51.9% 对 59.8%，差异为 7.9 个百分点 [95%CI，6.8 至 9.0 个百分点]；HF，39.8% 对 48.7%，差异为 8.9 个百分点 [CI，8.2 至 9.7 个百分点]）。2至9.7个百分点]）以及符合医疗补助双重资格和不符合双重资格的患者（AMI，52.8%对60.4%，差异，7.6个百分点[CI，6.9至8.4个百分点]；HF，39.7%对49.4%，差异，9.6个百分点[CI，9.2至10.1个百分点]）。医院之间的差异可解释急性心肌梗死随访差异的 7.3 个百分点[CI，6.7 至 7.9 个百分点]，可解释高血压随访差异的 7.7 个百分点[CI，7.2 至 8.1 个百分点]：局限性：对其他支付方的可推广性：结论：要进一步缩小急性心肌梗死患者和高血压患者随访护理方面的差距，需要制定公平的政策和医疗系统策略：国家老龄化研究所。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Internal Medicine 医学-医学：内科

CiteScore

23.90

自引率

1.80%

发文量

1136

审稿时长

3-8 weeks

期刊介绍： Established in 1927 by the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine’s mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.