Heart failure hospitalization and mapping of post-discharge care: insights from a slovakian cohort study

Introduction Heart failure (HF) is the leading cardiovascular cause of hospitalization with high in-hospital and post-discharge mortality rates. Current heart failure guidelines strongly recommend an outpatient visit within six weeks after discharge for guideline-directed medical therapy (GDMT) up-titration to reduce the risk of rehospitalization or death. Purpose This study aims to map the journey of patients with their first HF hospitalization in Slovakia in the timeframe of 6 months before and after hospitalization to describe opportunities for improvement in HF management. Methods This retrospective cohort study analysed the first hospitalization for the ICD-10 diagnosis of I50.* (any HF) from October 2022 to September 2023, using data from the health insurance company (n = 3774). Healthcare services provided, specifically cardiology outpatient cardiology visits (COV), were assessed over the six-month period before and after hospitalization. A Cox-regression model incorporating COV as a time-dependent variable was used to evaluate the primary combined outcome defined as time to first rehospitalization or death. Results Among the 3,774 patients hospitalized for heart failure, 39.6% had a COV during the six months prior to hospital admission. 623 patients (16.5%) died during hospitalization. Out of 3,151 patients discharged, 1,551 (49.2%) had a COV, 497 (15.8%) were rehospitalized, 304 (9.6%) died, and 799 (25.4%) experienced none of these events (see figure 1). For patients with a COV, the median time to COV was 39 days. Only 834 patients (26.5%) attended a COV within the guideline-recommended six-week window post-discharge. Among those with a COV, 229 (14.8%) were rehospitalized, 57 (3.7%) died, and 1,265 (81.6%) experienced neither event. Conversely, 50.8% of the discharged patients did not have a COV within six months after HF hospitalization. Patients with no COV had higher rates of rehospitalization (n=497, 31.1%) and mortality (n=304, 19.0%), with only 799 (50.0%) experiencing neither event. A post-discharge COV was associated with a 26% lower hazard of death or rehospitalization (HR = 0.74, CI = 0.64-0.86, p<0.001) after adjusting for age, sex, and prior COV before hospitalization. Limitation of this analysis is the lack of access to clinical data for a multivariable comparison between patient groups. Strength is that healthcare administrative database provides unselected real-world data. Conclusion Access to cardiology outpatient care plays a crucial role in the outcomes of patients following hospitalization for heart failure. Post-discharge cardiology outpatient visits were linked to a significantly lower risk of death or rehospitalization. Only about a quarter of patients after their first HF hospitalization had a cardiology outpatient visit during the first 6 weeks after discharge. These results support efforts to introduce innovative health care services, promoting flexible access to specialized care to increase GDMT provision.