Physician Continuity Improves Outcomes for Heart Failure Patients Treated and Released From the Emergency Department

ObjectivesThe goal of this study was to evaluate the effect of physician continuity for patients with heart failure (HF) treated and released from the emergency department (ED).BackgroundAlthough current guidelines recommend early follow-up after hospital discharge, it is unclear if it is beneficial in patients sent home from the ED and whether this follow-up should be with a familiar physician.MethodsThis was a retrospective cohort of all adults treated and released from 93 EDs in Alberta, Canada, from 1999 to 2009 with a first-time most responsible diagnosis of HF. Cox proportional hazards models with time-varying covariates for post-ED outpatient visits were used.ResultsIn 12,285 patients (mean age 74.9 years), the rate of death or all-cause hospitalization at 6 months was lower in those who saw a familiar physician (37.3%; adjusted hazard ratio [aHR]: 0.89 [95% confidence interval (CI): 0.83 to 0.96]) in the first month versus those with no outpatient visits (58.1%; aHR: 1.00 [referent]) or visits only with unfamiliar physicians (40.2%; aHR: 1.04 [95% CI: 0.94 to 1.15]). Taking into account all outpatient visits over each observation period and excluding those without follow-up, death or hospitalization was less common in those patients being followed up by a familiar physician (aHR of 0.79 [95% CI: 0.71 to 0.89] at 3 months; aHR of 0.86 [95% CI: 0.77 to 0.95] at 6 months; and aHR of 0.87 [95% CI: 0.80 to 0.96] at 12 months compared with unfamiliar physician follow-up). Any follow-up within 30 days of ED release was associated with a lower risk of repeat ED visit or death at 6 months (aHR: 0.78 [95% CI: 0.73 to 0.82] for familiar physicians; aHR: 0.79 [95% CI: 0.72 to 0.86] for unfamiliar physicians).ConclusionsEarly follow-up after an ED visit is associated with better outcomes, particularly if conducted with a familiar physician.