Lack of Timely Follow-Up Care After Heart Failure Common in Type 2 Diabetes

A version of this article was originally published on HCPLive^® by managing editor, Patrick Campbell. This version has been lightly edited.

A new study¹ of adults with type 2 diabetes (T2D) using Medicaid details a grim reality: Less than 50% of these adults receive follow-up care within the recommended period following a first-time hospitalization for heart failure.

Results of an analysis of more than 9800 adult patients with T2D and a first-time hospitalization for heart failure covered by Alabama Medicaid suggest just 41.6% of patients had an ambulatory follow-up within the recommended 14 days after hospitalization, with more than 1 in 4 going 60 days or more without seeing a care provider following hospitalization. Results of the study, in which the patient population was more than 47% African American adults, also shed light on racial disparities in follow-up care.¹

Findings published recently in Journal of the American Heart Association.

“The study underscores a necessity to develop interventions that will facilitate guideline-directed treatment and care for patients with T2D and heart failure, especially for those with Medicaid or people of underrepresented races and ethnicities,” said lead investigator Yulia Khodneva, MD, PhD, an assistant professor of medicine and primary care physician at the University of Alabama School of Medicine in Birmingham, in a statement.²

The current study was an observational retrospective secondary analysis of Medicaid claims data collected within the Alabama Care Plan study; it aimed to evaluate the quality of care for diabetes among Alabama Medicaid beneficiaries. The study provided data related to a cohort of 9859 adult patients with T2D and first hospitalization for heart failure from 2010 to 2019.¹

This cohort had a mean (SD) age at discharge of 53.7 (9.2) years, 41.8% were non-Hispanic White, 47.3% were Black, and 10.9% were Hispanic/Other (non‐White Hispanic, American Indian, Pacific Islander, and Asian). Investigators noted 19.7% of the cohort had a rural residence and the primary reason for Medicaid eligibility among the cohort was disability (92.4%).¹

The primary outcome of interest for the analysis was ambulatory care use within 60 days after discharge. For the purpose of analysis, ambulatory care use was defined as first primary care visit, first cardiology visit, and first endocrinology care visit within the 60‐day post-discharge period. Investigators further stratified patients based on visits within the 60-day follow-up period, with these groups defined as those who had any ambulatory care visits within 0 to 7 days after discharge, 8 to 14 days after discharge, 15 to 60 days after discharge, and no vists within 60 days after discharge.¹

Upon analysis, results indicated 26.7% of the study cohort had an ambulatory visit within 0 to 7 days, 15.2% had a visit within 8 to 14 days, 31.3% had a visit within 15 to 60 days, and 26.8% had no visit. Among those with a visit, 71% saw a primary care physician; 12%, a cardiologist; and 1.6%, an endocrinologist. The investigators noted participants were seen sooner in the primary care setting (median [IQR] time to visit, 13 [5-25] days) than in the cardiology (19 [7-35] days) or endocrinology (26 [I11-37] days) setting.¹

Further analysis revealed Black and Hispanic/Other adults were less likely than their non-Hispanic White counterparts to have any postdischarge ambulatory visit (P < .0001), to have visits in which they experienced delays (by 1.8 days, P = .0006; by 2.8 days, P = .0016, respectively), and to be seen by a primary care physician (adjusted incidence rate ratio [aIRR], 0.96; 95% CI, 0.91-1.00; and aIRR, 0.91; 95% CI, 0.89-0.98).¹

“Hopefully, this study will trigger additional, more in-depth studies that may help to explain the reasons for these observed racial disparities and help in the development of interventions to promote prompt follow-up for these patients,” Khodneva said.²

References

1. Khodneva Y, Levitan EB, Arora P, Presley CA, Oparil S, Cherrington AL. Disparities in postdischarge ambulatory care follow-up among Medicaid beneficiaries with diabetes, hospitalized for heart failure. J Am Heart Assoc. Published online June 7, 2023. doi:10.1161/JAHA.122.029094

2. Lack of timely follow-up after heart failure hospitalization for most adults with diabetes. News release. American Heart Association. June 7, 2023. Accessed June 7, 2023. https://newsroom.heart.org/news/lack-of-timely-follow-up-after-heart-failure-hospitalization-for-most-adults-with-diabetes