Early Follow-Up After Heart Failure Hospitalizations Remains Low and Variable Across Hospitals: Insights from the Michigan

Introduction: Early outpatient follow-up may improve outcomes for hospitalized heart failure patients, and is being considered as an ACC/AHA heart failure performance measure. Hypothesis: We evaluated patterns and determinants of early outpatient follow-up after heart failure hospitalization across Michigan hospitals. Methods: The sample used in this analysis included all patients hospitalized with a primary diagnosis of heart failure between January 1, 2017 and December 31, 2019 in the Michigan Value Collaborative statewide multipayer claims data registry. Early follow-up was defined as an outpatient evaluation and management visit within 7 days of discharge. Multilevel mixed-effects models were used to evaluate risk-adjusted early follow-up rates after heart failure hospitalization, adjusting for patient and discharging hospital factors. Results: A total of 17,203 of 39,505 (43.6%) patients hospitalized for heart failure had an early follow-up visit after discharge, which increased from 41.3% in 2017 to 43.0% in 2018 and 46.1% in 2019 (p<0.001). Predictors of early follow-up include male sex, increasing age, commercial insurance coverage, angina, coagulopathy, lung disease, metabolic disorders, arrhythmia, vascular disease, hospital not-for-profit status, non-teaching hospital, and non-rural location. After adjustment, hospital-level rates of early follow-up ranged from 18.1% to 65.7%, with a median of 42.0% (Figure). Patient and hospital factors account for 1.4% and 36.3% of the variation in hospital-specific rates of early follow-up, with 62.3% of the variation left unexplained. Conclusions: Less than half of hospitalized heart failure patients have an early follow-up after discharge, with patient factors accounting 2% of the variation. A more thorough understanding of the determinants of successful early follow-up after heart failure hospitalization and its impact on outcomes will better inform quality improvement efforts.