@article {AtzemaE1468, author = {Clare L. Atzema and Peter C. Austin and Bing Yu and Michael J. Schull and Cynthia A. Jackevicius and Noah M. Ivers and Paula A. Rochon and Douglas S. Lee}, title = {Effect of early physician follow-up on mortality and subsequent hospital admissions after emergency care for heart failure: a retrospective cohort study}, volume = {190}, number = {50}, pages = {E1468--E1477}, year = {2018}, doi = {10.1503/cmaj.180786}, publisher = {CMAJ}, abstract = {BACKGROUND: The 1-year mortality rate in patients with heart failure who are discharged from an emergency department is 20\%. We sought to determine whether early follow-up after discharge from the emergency department was associated with decreased mortality or subsequent admission to hospital.METHODS: This retrospective cohort study conducted in Ontario, Canada, included adult patients who were discharged from 1 of 163 emergency departments between April 2007 and March 2014 with a primary diagnosis of heart failure. Using a propensity score{\textendash}matched landmark analysis, we assessed follow-up in relation to mortality and admissions to hospital for cardiovascular conditions.RESULTS: Of 34 519 patients, 16 274 (47.1\%) obtained follow-up care within 7 days and 28 846 (83.6\%) within 30 days. Compared with follow-up between day 8 and 30, patients with follow-up care within 7 days had a lower rate of mortality over 1 year (hazard ratio [HR] 0.92; 95\% confidence interval [CI] 0.87{\textendash}0.97), and a reduced rate of admission to hospital over 90 days (HR 0.87, 95\% CI 0.80{\textendash}0.94) and 1 year (HR 0.92; 95\% CI 0.87{\textendash}0.97); the mortality rate over 90 days in this group trended to a lower rate (HR 0.90, 95\% CI 0.10{\textendash}1.00). Follow-up care within 30 days, compared with patients without 30-day follow-up, was associated with a reduction in 1-year mortality (HR 0.89, 95\% CI 0.82{\textendash}0.97) but not admission to hospital (HR 1.02, 95\% CI 0.94{\textendash}1.10). In this group, there was a trend toward an increase in 90-day admission to hospital (HR 1.14, 95\% CI 1.00{\textendash}1.29).INTERPRETATION: Follow-up care within 7 days of discharge from the emergency department was associated with lower rates of long-term mortality, as well as subsequent hospital admissions, and a trend to lower short-term mortality rates. Timely access to longitudinal care for patients with heart failure who are discharged from the emergency setting should be prioritized.}, issn = {0820-3946}, URL = {https://www.cmaj.ca/content/190/50/E1468}, eprint = {https://www.cmaj.ca/content/190/50/E1468.full.pdf}, journal = {CMAJ} }