Early Follow-Up Appointments for Congestive Heart Failure Admissions

Introduction: Congestive heart failure (CHF) admissions place a financial burden on patients and the healthcare system. The national direct medical costs of CHF have reached $20.9 billion and a CHF related hospitalization costs $14,631 per patient. Studies have demonstrated an association between early post-discharge follow up within 7 days and a reduction in readmission rates. Our study attempts to characterize the rates of follow up appointments in patients discharged from the medicine service in an urban academic hospital. Hypothesis: We hypothesized the rate of early follow-up appointments provided to patients with a diagnosis of an acute CHF exacerbation will be low. Methods: We performed a chart review of patients admitted to our institution from January 2016- February 2017 to the medicine service, including regular medicine floor and telemetry units, with a primary or secondary discharge diagnosis of acute systolic or diastolic heart failure. Discharge paperwork was reviewed for presence of an appointment with a primary care physician (PCP) or cardiologist scheduled within 7 days of discharge, including date and time of appointment. Patients discharged from the cardiology or other services and patients with dispositions of hospice or death were excluded. Results: Over a 13 month period, 63 patients were discharged from the medicine service with a primary or secondary diagnosis of CHF, twelve patients were excluded due to disposition. Among 51 patients, 15.7% (CI 95%, 0.07-0.286) were scheduled for follow-up appointment within 7 days of discharge with a PCP or cardiologist and 2 patients had appointments documented after 7 days. Therefore, 80.4% of patients (CI 95%, 0.695-0.913) did not have any scheduled follow up on their discharge summaries. Conclusion: In conclusion, the majority of CHF patients admitted to the medicine service of our institution are not provided appointments within 7 days of discharge. Data has shown that early follow up appointments are associated with reduced readmission rates. Lowering CHF readmissions are important for reducing medical complications and financial burden on patients and the healthcare system. Our future interventions will focus on increasing the number of patients with appropriate 7 day follow up with the aim to reduce readmissions and medical complications.