Hospitals risk readmissions, penalties with poor heart failure follow-up

Heart failure patients who return to a provider for a simple follow-up visit within seven days of hospital discharge are 15 percent less likely to be readmitted within 30 days, a study published in today's Journal of the American Medical Association reveals. Yet despite the existing recommendation to conduct these visits, fewer than 40 percent of the 30,000 heart patients studied were brought back to be reevaluated.

One question is whether the responsibility for follow-up visits after discharge lies with the hospital or the physician, Dr. Robert O. Bonow, chief of the division of cardiology at the Northwestern University School of Medicine and a spokesman for the American Heart Association, told HealthDay News. But the research, combined with Medicare's upcoming penalties for preventable readmissions, puts the issue in hospitals' court, Bonow says.

Barriers to follow-up visits include current lack of financial incentives for hospitals to report readmissions and physicians' hectic schedules. However, Bonow points out that follow-up by a visiting nurse may be as effective as seeing a doctor. Efforts to bring care to patients may also prove more reliable, as heart failure patients tend to be elderly and suffer from additional chronic conditions.

Study author Dr. Adrian F. Hernandez, an assistant professor of medicine at Duke University School of Medicine in Durham, N.C., who said he chose to study heart failure readmissions because they represent such a large part of hospitals' overall readmission problem, recommended that hospitals implement a safety net that would schedule a visit to a discharged patient if one is not conducted soon after the hospital stay.

Dr. Alfred A. Bove, of the American College of Cardiology, added, "Until now, early follow-up for heart failure patients after discharge had face validity only. This study confirms the importance of establishing coordinated systems of care in which patients are evaluated early after discharge."

To learn more:
- read this HealthDay News piece via U.S. News & World Report
- here's the JAMA abstract
- read this American College of Cardiology commentary