Early visits may provide key to lowering atrial fibrillation readmissions

Patients with atrial fibrillation and comorbid conditions may benefit from follow-up outpatient visits in the first 14 days following a hospitalization, reducing the risks of 30-, 60-, or 90-day readmissions, according to a study published in the May/June issue of the American Journal of Medical Quality.

Atrial Fibrillation is a major health problem in the U.S., with an estimated 2.66 million patients in 2010 experiencing symptoms. Most of these patients are 65 years or older, about 80 percent, and as such Centers for Medicare & Medicaid Services (CMS) bears much of the burden of the cost and outcomes. According to lead author Mai Hubbard, PhD, of Mathematica Policy Research in Cambridge, Mass., and colleagues, evaluation and management visits in the office may play an important role in reducing the risk of readmission for patients with atrial fibrillation and other chronic diseases.

Studying CMS beneficiary data, the researchers noticed that the average number of hospitalizations for atrial fibrillation patients was 54 percent higher than other chronic diseases and about a fifth of those patients were likely to have had two or more hospitalizations in the baseline year, as opposed to other chronic diseases (12 percent). Atrial fibrillation patients were 37 percent more likely to have high numbers of outpatient visits, getting in to see their physicians between two, seven or 14 days following discharge, and were 37 percent more costly.

Still, in patients who saw a provider for an evaluation and management visit within 14 days of discharge, they found a lower 30-day readmission rate (17 percent lower for atrial fibrillation patients or 23.5 percent in the chronic disease comparison group).  Atrial fibrillation patients who had an outpatient visit also saw 15.5 percent lower rates on 60-day and 12.9 percent lower rates on the 90-day readmission mark. These findings were on par for the other chronic diseases group.

While patients appeared to benefit more from having these early visits, only about half of either group had an outpatient visit. Without more defined data as to why patients didn’t have a follow-up visit, Hubbard et al suggested that factors may include age and patient’s illness severity.

They stated, “These findings underscore the need for CMS to examine health outcomes for beneficiaries with AF [atrial fibrillation], who present equal, if not slightly more, challenges compared with beneficiaries with other common chronic conditions.”