Characteristics of patients with heart failure included in the study
| Characteristic | Physician continuity within 30 d after discharge; no. (%) of patients* | p value‡ | |||
|---|---|---|---|---|---|
| No visits n = 5 336 | All visits with unfamiliar physician(s) n = 2 182 | ≥ 1 visit with familiar physician(s)† n = 16 855 | Overall n = 24 373 | ||
| Male sex | 2 389 (44.8) | 1 146 (52.5) | 8 692 (51.6) | 12 227 (50.2) | < 0.001 |
| Age, yr, mean ± SD | 78.9 ± 12.5 | 74.3 ± 13.6 | 75.7 ± 11.6 | 76.3 ± 12.1 | < 0.001 |
| Rural residence | 1 528 (28.6) | 508 (23.3) | 4 219 (25.0) | 6 255 (25.7) | < 0.001 |
| Use of health care resources | |||||
| ≥ 1 emergency department visit in previous yr | 4 130 (77.4) | 1 545 (70.8) | 12 546 (74.4) | 18 221 (74.8) | < 0.001 |
| No. of emergency department visits in previous yr, mean ± SD | 3.0 (4.6) | 2.5 (4.5) | 2.7 (4.5) | 2.8 (4.5) | < 0.001 |
| ≥ 1 hospital admission in previous yr | 2 838 (53.2) | 917 (42.0) | 8 152 (48.4) | 11 907 (48.9) | < 0.001 |
| No. of admissions in previous yr, mean ± SD | 1.1 (1.7) | 0.8 (1.4) | 0.9 (1.4) | 1.0 (1.5) | < 0.001 |
| No. of physician office visits in previous yr, mean ± SD | 8.9 (8.0) | 9.8 (8.6) | 15.9 (11.5) | 13.8 (11.1) | < 0.001 |
| No. of unique providers (office claims) in previous yr, mean ± SD | 2.8 (2.2) | 3.5 (2.6) | 4.1 (2.6) | 3.8 (2.5) | < 0.001 |
| Specialist seen for any cause in previous yr | 1 844 (34.6) | 901 (41.3) | 8 702 (51.6) | 11 447 (47.0) | < 0.001 |
| Specialist seen during index admission | 2 766 (51.8) | 1 400 (64.2) | 9 842 (58.4) | 14 008 (57.5) | < 0.001 |
| Specialist seen during index admission or in previous yr | 3 358 (62.9) | 1 658 (76.0) | 12 503 (74.2) | 17 519 (71.9) | < 0.001 |
| ICU admission during index admission | 805 (15.1) | 421 (19.3) | 3 040 (18.0) | 4 266 (17.5) | < 0.001 |
| Length of stay of index admission, d, median (IQR) | 10 (6–21) | 9 (5–15) | 8 (5–14) | 8 (5–15) | < 0.001 |
| Charlson Comorbidity Index score§ at discharge, mean ± SD | 4.5 (2.2) | 4.2 (2.1) | 4.1 (2.0) | 4.2 (2.1) | < 0.001 |
| LACE score¶ at discharge, mean ± SD | 13.8 (2.7) | 13.3 (2.6) | 13.2 (2.6) | 13.3 (2.6) | < 0.001 |
| Comorbidities at discharge | |||||
| Diabetes | 1 737 (32.6) | 682 (31.3) | 6 085 (36.1) | 8 504 (34.9) | < 0.001 |
| Hypertension | 2 858 (53.6) | 1 224 (56.1) | 9 795 (58.1) | 13 877 (56.9) | < 0.001 |
| Dementia | 762 (14.3) | 179 (8.2) | 885 (5.3) | 1 826 (7.5) | < 0.001 |
| COPD | 2 119 (39.7) | 831 (38.1) | 6 478 (38.4) | 9 428 (38.7) | 0.2 |
| Anemia | 1 410 (26.4) | 519 (23.8) | 4 068 (24.1) | 5 997 (24.6) | 0.002 |
| Cardiovascular disease | 678 (12.7) | 189 (8.7) | 1 515 (9.0) | 2 382 (9.8) | < 0.001 |
| Renal disease | 1 048 (19.6) | 413 (18.9) | 3 195 (19.0) | 4 656 (19.1) | 0.5 |
| Cancer | 386 (7.2) | 134 (6.1) | 1 124 (6.7) | 1 644 (6.7) | 0.2 |
| Peripheral vascular disease | 616 (11.5) | 236 (10.8) | 1 834 (10.9) | 2 686 (11.0) | 0.4 |
| Atrial fibrillation | 1 945 (36.5) | 801 (36.7) | 6 810 (40.4) | 9 556 (39.2) | < 0.001 |
| Prior MI | 1 215 (22.8) | 473 (21.7) | 3 914 (23.2) | 5602 (23.0) | 0.2 |
| Prior revascularization | 81 (1.5) | 61 (2.8) | 605 (3.6) | 747 (3.1) | < 0.001 |
| Prior MI or prior revascularization | 1 237 (23.2) | 496 (22.7) | 4 093 (24.3) | 5 826 (23.9) | 0.1 |
Note: COPD = chronic obstructive pulmonary disease, ICU = intensive care unit, IQR = interquartile range, MI = myocardial infarction, SD = standard deviation.
↵* Unless stated otherwise.
↵† A familiar physician is defined as one who had seen the patient at least twice in the year before the index hospital admission or once during the index admission.
↵‡ Values were calculated using the Pearson χ2 test for categorical variables and analysis of variance for continuous variables.
↵§ The Charlson Comorbidity Index score was calculated using 1 point for history of MI, peripheral vascular disease, cerebrovascular disease or diabetes without complications; 2 points for congestive heart failure, COPD, mild liver disease or cancer; 3 points for dementia or connective tissue disease; 4 points for moderate to severe liver disease or HIV infection; and 6 points for metastatic cancer.
↵¶ LACE is a nmemonic derived from variables independently associated with the outcome of death or urgent readmission within 30 d after discharge (length of stay [“L”]; acuity of the admission [“A”]; comorbidity of the patient, as measured with the Charlson Comorbidity Index score [“C”]; and emergency department use, measured as the number of visits in the 6 mo before admission [“E”]).