Outpatient healthcare utilization 30 days before and after hospitalization for heart failure in France: Contribution of the national healthcare database (Systèmenationaldesdonnéesdesanté).

Guidelines have been published concerning patient management after hospitalization for heart failure. The French national healthcare database (Systèmenationaldesdonnéesdesanté; SNDS) can be used to compare these guidelines with real-life practice. To study healthcare utilization 30 days before and after hospitalization for heart failure, and the variations induced by the exclusion of institutionalized patients, who are less exposed to outpatient healthcare utilization. We identified the first hospitalization for heart failure in 2015 of adult beneficiaries of the health insurance schemes covering 88% of the French population, who were alive 30 days after hospitalization. Outpatient healthcare utilization rates during the 30 days after hospitalization and the median times to outpatient care, together with their interquartile ranges, were described for all patients, and for a subgroup excluding institutionalized patients. Among the 104,984 patients included (mean age 79 years; 52% women), 74% were non-institutionalized (mean age 78 years; 47% women). The frequencies of at least one consultation after hospitalization and the median times to consultation were 69% (total sample) vs. 78% (subgroup excluding institutionalized patients) and 8 days (interquartile range 3; 16) vs. 7 days (3; 15) for general practitioners, 20% vs. 21% and 14 days (7; 23) vs. 16 days (9; 24) for cardiologists and 58% vs. 69% and 3 days (1; 9) vs. 2 days (1; 7) for nurses, with reimbursement of diuretics in 77% vs. 86%, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in 48% vs. 55% and beta-blockers in 55% vs. 63%. Departmental variations, excluding institutionalized patients, were large: general practice consultations (interquartile range 74%; 83%), cardiology consultations (11%; 23%) and nursing care (68%; 77%). Low outpatient healthcare utilization rates, long intervals to first healthcare utilization and departmental variations indicate a mismatch between guidelines and real-life practice, which is accentuated when including institutionalized patients.

Feldman SF ，Lesuffleur T ，Olié V ，Gastaldi-Ménager C ，Juillière Y ，Tuppin P ... -  《-》

French annual national observational study of 2015 outpatient and inpatient healthcare utilization by approximately half a million patients with previous heart failure diagnosis.

Heart failure management guidelines have been published, but the degree of adherence to these guidelines remains unknown. To study in 2015 healthcare utilization and causes of death for people previously identified with heart failure. The national health data system was used to identify adult general scheme (86% of the French population) hospitalized for heart failure between 2011 and 2014 or with only a long-term chronic disease allowance for heart failure. The frequency and median (interquartile range) of at least one healthcare use among those still alive in 2015 was calculated. A total of 499,296 adults (1.4% of the population) were included, and 429,853 were alive in 2015; median age 79 (68-86) years. At least one utilization was observed for a general practitioner in 95% of patients (median 8 [interquartile range 5-13] consultations), a cardiologist in 42% (2 [1-3]), a nurse in 78% (16 [4-100]), a loop diuretic in 64% (11 [8-12] dispensations), an aldosterone antagonist in 21% (8 [5-11]), a thiazide in 15% (7 [4-11]), a renin-angiotensin system inhibitor in 68% (11 [8-13]), a beta-blocker in 65% (11 [7-13]), a beta-blocker plus a renin-angiotensin system inhibitor in 57%, and a beta-blocker plus a renin-angiotensin system inhibitor plus an aldosterone antagonist in 37%. Hospitalization for heart failure was present for 8% (1 [1,2]). Higher levels of healthcare utilization were observed in the presence of hospitalization for heart failure before 2015. Among the 13.9% of people who died in 2015, heart failure accounted for 8% of causes, cardiovascular disease accounted for 39%. General practitioners and nurses are the main actors in the regular follow-up of patients with heart failure, whereas cardiologist consultations and dispensing of first-line treatments are insufficient with respect to guidelines.

Feldman SF ，Lesuffleur T ，Olié V ，Gastaldi-Ménager C ，Juillière Y ，Tuppin P ... -  《-》

Practice Patterns and Patient Outcomes After Widespread Adoption of Remote Heart Failure Care.

Yuan N ，Botting PG ，Elad Y ，Miller SJ ，Cheng S ，Ebinger JE ，Kittleson MM ... -  《-》

Temporal Trends and Variation in Early Scheduled Follow-Up After a Hospitalization for Heart Failure: Findings from Get With The Guidelines-Heart Failure.

Previous data demonstrate early follow-up (ie, within 7 days of discharge) after a hospitalization for heart failure is associated with a lower risk of readmission, yet is uncommon and varies widely across hospitals. Limited data exist on whether the use of early follow-up after discharge has improved over time. We used data from Get With The Guidelines-Heart Failure (GWTG-HF) linked to Medicare claims to examine temporal trends in early follow-up and to assess for patient and hospital characteristics associated with early scheduled follow-up. In the overall GWTG-HF cohort, we studied 52,438 patients discharged from 239 hospitals from 2009 to 2012. Scheduled early follow-up at the time of hospital discharge rose from 51% to 65% over time (P<0.001). After multivariable adjustment, patients with older age (odds ratio, 1.04; 95% confidence interval, 1.01-1.07), certain comorbidities (anemia, diabetes mellitus, and chronic kidney disease), and the use of anticoagulation at discharge (odds ratio, 1.16; 95% confidence interval, 1.11-1.22) were associated with greater likelihood for early scheduled follow-up. Patients treated in hospitals located in the Midwest (odds ratio, 0.67; 95% confidence interval, 0.50-0.91) were less likely to have early scheduled follow-up. In a subset of patients with linked Medicare claims, we observed smaller improvements in actual early follow-up visits over time from 26% to 30% (P=0.005). From 2009 to 2012, there was improvement in early scheduled outpatient follow-up and, in the subset analyzed, improvement in actual early follow-up visits for hospitalized patients with heart failure. However, substantial opportunities remain for improving heart failure transitional care.

DeVore AD ，Cox M ，Eapen ZJ ，Yancy CW ，Bhatt DL ，Heidenreich PA ，Peterson ED ，Fonarow GC ，Hernandez AF ... -  《-》

Evaluation of the prescribing practice of guideline-directed medical therapy among ambulatory chronic heart failure patients.

Parajuli DR ，Shakib S ，Eng-Frost J ，McKinnon RA ，Caughey GE ，Whitehead D ... -  《BMC Cardiovascular Disorders》