Predicted Mortality and Cardiology Follow-up Following Heart Failure Hospitalizations Among Veterans Health Administration Patients.

Abstract

Background: Guidelines recommend timely follow-up with a cardiology specialist for patients hospitalized with heart failure (HF), but it is unknown whether the timeliness of specialty cardiovascular care after discharge correlates with clinical risk. We south to assess the association between estimated mortality risk and post-HF hospitalization cardiology follow-up.

Methods and results: In a cohort of veterans hospitalized with HF in acute care Veterans Health Administration (VA) hospitals between January 1, 2018, and September 15, 2022, we estimated the association of mortality risk at discharge with postdischarge cardiology encounters via logistic regression. We also evaluated the association between cardiology visits and sociodemographic and clinical characteristics, and described variability in postdischarge follow-up rates across VA facilities. We identified a cohort of 84,348 veterans hospitalized with HF with 120,619 hospital admissions. Of a subcohort of 57,554 veterans with 79,866 hospitalizations surviving at least 1 year after discharge, 32.1% of hospitalizations were followed by a cardiology visit within 2 weeks, and 49.3% within 1 month. Marginal probabilities of 2-week and 1-month follow-up were higher for hospitalizations in the highest-risk quintile than those in the lowest-risk quintile (34% vs. 30% and 51% vs. 47%, respectively; P < 0.001 for both intervals). In a time-to-event model in the full cohort, there was a slightly negative association between risk and likelihood of 1-month follow-up (coefficient for MAGGIC score = -0.004, 95% confidence interval [CI] -0.005 to -0.003). Black veterans were less likely to have either 2-week or 1-month follow-up (adjusted odds ratios, 0.93 [95% CI 0.90-0.97] for 2 weeks and 0.93 [95% CI 0.89-0.96] for 1 month). Female veterans were also less likely to have follow-up within 1 month of hospital discharge (adjusted odds ratio 0.90 [95% CI 0.90-0.98]). Conversely, patients with a primary vs secondary hospital diagnosis of HF and those with reduced vs preserved ejection fraction were more likely to have 2-week follow-up (adjusted odds ratios 1.67 [95% CI 1.62-1.73] and 1.72 [95% CI 1.67-1.78], respectively) and 1-month follow-up (adjusted odds ratios 1.83 [95% CI 1.78-1.88] and 1.85 [95% CI 1.80-1.90], respectively). The 1-month follow-up rates varied from 5% to 69% across VA facilities.

Conclusions: The rate of visits with a cardiologist within 2 weeks or 1 month after HF hospitalization was low overall, was at most modestly associated with estimated mortality risk at discharge, and varied by sex, race/ethnicity, and across VA facilities. Increasing the visit rate after HF hospitalization should be evaluated as a mechanism to improve outcomes after HF hospitalizations, particularly for higher-risk individuals.