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Post-discharge Follow-up Characteristics Associated With 30-Day Readmission After Heart Failure Hospitalization

Lee, Keane K. MD, MS; Yang, Jingrong MA; Hernandez, Adrian F. MD, MHS; Steimle, Anthony E. MD; Go, Alan S. MD

doi: 10.1097/MLR.0000000000000492
Original Articles

Background: Readmission within 30 days after hospitalization for heart failure (HF) is a major public health problem.

Objective: To examine whether timing and type of post-discharge follow-up impacts risk of 30-day readmission in adults hospitalized for HF.

Design: Nested matched case-control study (January 1, 2006–June 30, 2013).

Setting: A large, integrated health care delivery system in Northern California.

Participants: Hospitalized adults with a primary diagnosis of HF discharged to home without hospice care.

Measurements: Outpatient visits and telephone calls with cardiology and general medicine providers in non-emergency department and non-urgent care settings were counted as follow-up care. Statistical adjustments were made for differences in patient sociodemographic and clinical characteristics, acute severity of illness, hospitalization characteristics, and post-discharge medication changes and laboratory testing.

Results: Among 11,985 eligible adults, early initial outpatient contact within 7 days after discharge was associated with lower odds of readmission [adjusted odds ratio (OR)=0.81; 95% CI, 0.70–0.94], whereas later outpatient contact between 8 and 30 days after hospital discharge was not significantly associated with readmission (adjusted OR=0.99; 95% CI, 0.82–1.19). Initial contact by telephone was associated with lower adjusted odds of 30-day readmission (adjusted OR=0.85; 95% CI, 0.69–1.06) but was not statistically significant.

Conclusions: In adults discharged to home after hospitalization for HF, outpatient follow-up with a cardiology or general medicine provider within 7 days was associated with a lower chance of 30-day readmission.

Supplemental Digital Content is available in the text.

*Division of Research, Kaiser Permanente Northern California, Oakland

Department of Cardiology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA

Duke Clinical Research Institute, Duke University, Durham, NC

§Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, San Francisco

Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website,

Supported by research grants from the Kaiser Permanente Northern California Community Benefit Fund and grants RC1HL099395 and U19HL091179 from the National Heart, Lung and Blood Institute of the National Institutes of Health, US Department of Health and Human Services.

The authors report no conflict of interest.

Reprints: Keane K. Lee, MD, MS, Department of Cardiology (348), Kaiser Permanente Santa Clara Medical Center, 710 Lawrence Expressway, Santa Clara, CA 95051. E-mail:

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