12 December 2018

GP visits critical in post CVD hospitalisation care

Cardio General Practice Research

GPs are vital to saving lives and reducing ED visits after heart attacks, new research reveals.

In one of the first studies of this kind, Australian researchers analysed health data from GPs, public hospitals, cardiologists and death records.

When researchers analysed information from 37,300 patients from Victoria and New South Wales who had been hospitalised for coronary heart disease, they found regular contact with a GP helped avert the high chance of hospital readmission in the following three months.

An Australian Institute of Health and Welfare (AIHW) spokesperson Dr Lynelle Moon said data showed high rates of hospital readmission for such patients, especially in the period soon after hospital discharge.

“Overall, one in four patients had an emergency readmission relating to coronary heart disease within the two-year period, with 40% of these people readmitted after their hospital stay within 90 days of being discharged from hospital,” she said in a statement.

The report, titled Transition between hospital and community care for patients with coronary heart disease, found that “timely and regular” contact with a GP was a protective action.

Overall, half of all patients who didn’t see their GP wound up back in the emergency department.

This dropped to one in five if they followed up with their GP, the report shows.

“Even after accounting for all other factors, the data showed the risk of emergency readmission was significantly lower for people who visited a GP,” Dr Moon said.

When the researchers accounted for risks such as age and the complexity of disease, they still found the risk of having an emergency cardiovascular readmission was around 13% lower in those who visited their GP one to two times each month over the two-year follow-up period than those who didn’t at all.

Almost one in 10 patients died in the two-year follow-up period, nearly half due to cardiovascular disease.

But patients reduced the risk of cardiovascular-related death by around 5% if they visited a GP, cardiologist or had a new chronic disease management plan within the two years of discharge.

Fortunately, more than half the patients saw their GPs within a week and eight in 10 did within the first month.

A recent study in the CMAJ echoed the AIHW findings.

Researchers found that when patients visited a doctor in the week after admission to the emergency department for heart failure, they were 8% less likely to die in the following year and 13% less likely to be back in the hospital in the subsequent three months, compared with those who saw a doctor within a month.

That said, getting follow up within the month was still better than avoiding it altogether. For these patients, they were 11% less likely to die than those who didn’t receive follow-up care with a physician, such as their family physician, cardiologist or internist.