Follow-up of cardiac hospitalizations lacking and disparities worsening, study finds
While follow-up after myocardial infarction or heart failure hospitalization gradually improved over a decade, disparities worsened for Asian, Black, Hispanic, and Medicaid dual-eligible patients, as well as patients residing in counties with higher levels of social deprivation.
Timely postdischarge follow-up after acute myocardial infarction (AMI) and heart failure (HF) hospitalizations increased substantially in 2010 to 2019, but many patients still do not get any follow-up, and racial and socioeconomic disparities on this front have worsened, a study found.
Researchers analyzed administrative claims for all Medicare fee-for-service beneficiaries hospitalized from 2010 to 2019 to describe trends and disparities in follow-up after 1,678,088 hospitalizations or observation stays for AMI and 4,245,665 for HF. Rates of a cardiology visit within 30 days of discharge were studied for changes over time overall and across five sociodemographic characteristics based on known disparities in cardiovascular outcomes. The findings were published Aug. 6 by Annals of Internal Medicine.
Overall, nearly 40% of patients with AMI and more than 50% of patients with HF were not seen by a cardiologist after discharge, and nearly 20% of patients with AMI and 30% of patients with HF were not seen by primary care or cardiology within 30 days of discharge, the study found. 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. Follow-up rates increased for all demographic subgroups but disparities worsened for Hispanic patients with AMI and patients with HF who were Asian, Black, Hispanic, Medicaid dual-eligible, or 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%; HF, 39.8% vs. 48.7%) and between patients who were or weren't dual-eligible (AMI, 52.8% vs. 60.4%; HF, 39.7% vs. 49.4%). Differences between hospitals explained 7.3 percentage points of the variation in follow-up for AMI and 7.7 percentage points of that for HF, the study authors calculated.
“Many patients are likely to benefit from follow-up with both cardiology and primary care given high rates of multimorbidity and polypharmacy, and thus strategies to coordinate postdischarge communication between patients, caregivers, primary care, and cardiology is vital,” they wrote. The authors noted that previous research has shown that 50% to 80% of HF patients have a postdischarge visit scheduled, “suggesting there is a large implementation gap between appointment scheduling and actual completion of a visit.”