Table 1:
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”]).