Summary

People with chronic conditions often require complex health care. For patients discharged from hospital with chronic conditions, regular follow-up visits to their primary health-care providers can be important for their long-term health. People with coronary heart disease (CHD, including heart attack or angina) are at higher risk of recurrent heart attacks and other cardiovascular diseases such as heart failure and atrial fibrillation. Effective and appropriate health care after an acute hospitalisation for CHD has been shown to improve a patient’s health outcomes.

In one of the first studies of its kind within Australia, the AIHW examined the health services used by people with CHD after their discharge from hospital. More than 37,300 CHD patients who were discharged from hospital between April 2012 and June 2013 were followed in the data for 2 years to see if visiting a general practitioner (GP) or a cardiologist, or claiming Medicare Benefits Schedule (MBS) items for specific health services, affected their chances of being re-admitted to hospital or dying.

The study analysed linked de-identified hospitalisation data from New South Wales and Victoria to MBS data and National Death Index data. By analysing linked multiple data sets, the study provides insights into hospital and community-based health care that cannot be explored using single data collections. It also provides a deeper understanding of the ways people interact with the health system, and may help to inform policies to improve health-care delivery for people with chronic conditions.

The study has shown that the vast majority of CHD patients visited their GP within 30 days of being discharged from hospital and that they had, on average, 1 or 2 visits per month during the two year timeframe. Timely and regular contact with a GP were associated with lower risk of having an emergency re-admission to hospital for cardiovascular disease (CVD).

Future research could explore how a person’s use of primary health-care services affects their pharmaceutical treatment, and focus on identifying approaches to improve regular primary health care use.

Most CHD patients were over 55

Eight in 10 (80%) patients hospitalised for CHD were aged over 55, and 3 in 10 (30%) were aged 65–74. More than two-thirds (68%) of all patients were men (25,400 compared with 12,000 women).

1 in 4 CHD patients were re-admitted to hospital and 1 in 10 died within 2 years

Almost 1 in 4 patients hospitalised for CHD (8,800; 24%) had at least 1 emergency re-admission due to cardiovascular disease (CVD) within 2 years of being discharged. About 40% of these people had their first emergency CVD re-admission within 90 days.

Almost 1 in 10 patients hospitalised for CHD died during the 2 year follow-up period (8%, 3,000 people). Around 40% of these deaths were due to CVD. One in 4 of the CVD related deaths occurred within 90 days after discharge.

CHD patients with co-existing conditions were at higher risk of having an emergency re-admission for CVD

People aged 75–84 had a 9% higher risk of emergency re-admission for CVD compared with those aged 25–54.

A higher risk for emergency re-admission was also found for people:

  • with an acute myocardial infarction (heart attack) who did not have cardiovascular procedures such as a percutaneous coronary angioplasty during the initial hospital stay
  • who had chronic obstructive pulmonary disease (COPD), renal failure or heart failure treated during the hospital stay, or previous hospitalisations.

The risk of dying from CVD was 7%–29% higher in patients who had cancer, COPD, renal failure or heart failure in the index hospital stay or previous hospitalisations.

8 in 10 CHD patients visited a GP within 30 days of being discharged

More than 9 in 10 (95%) of patients hospitalised for CHD had a follow-up visit with a GP within 2 years of being discharged. Eight in 10 visited their GP within 30 days (61% within the first week and 23% between 8 and 30 days). Over half of patients with CHD (56%) had a cardiologist follow-up, and this generally occurred after 30 days following discharge (35%). Most patients who made an MBS claim in relation to a new chronic disease management plan and health assessment did so after 30 days following discharge.

Follow-up care associated with lower risk of re-admission and death due to CVD

After controlling for a range of factors (such as age, sex, type of CHD diagnosis, coexisting conditions), patients with CHD who had at least 1 GP or cardiologist follow-up or claimed a new chronic disease management plan within 2 years of discharge from hospital had 5%–11% lower risk of emergency CVD re-admission and 4%–6% lower risk of CVD death than those who did not use these services.

Lower risk of emergency CVD re-admission for patients who had 1 to 2 GP visits per month

After controlling for the selected factors, the risk of having an emergency CVD re-admission was 12%–13% lower in CHD patients who, on average, visited a GP 1–2 times each month over the 2-year follow-up period than patients who did not visit a GP. The re-admission rate was not significantly different for patients with more than 2 GP visits per month than those who did not visit a GP.

Lower risk of emergency CVD re-admission for patients who visited a GP in first week and had evenly timed GP visits

After controlling for a range of factors, patients who had a GP follow-up within 1 week after discharge had 5% lower risk of emergency re-admission for CVD compared with those who visited a GP after 30 days. Patients with the most evenly timed GP visits had 13% lower risk of emergency CVD re-admission compared with those with more sporadic GP visits.