Most adults with diabetes do not get immediate outpatient care after being hospitalized for heart failure.

More than half of Alabama’s Medicaid-eligible adults with type 2 diabetes did not receive follow-up care within the recommended two weeks after hospitalization for newly diagnosed heart failure, according to a new study. The analysis, published today in the Journal of the American Heart Association, the open-access, peer-reviewed journal of the American Heart Association, found worse follow-up among African-American and Hispanic adults.

This large, racially diverse study also found that African-American and Hispanic adults were less likely than similar white adults to see their primary care physician after hospital discharge. bottom. When African-American and Hispanic adults had follow-up, it was about two to three days later than white adults.

Patients with type 2 diabetes are at increased risk of developing heart failure requiring hospitalization. American Heart Association guidelines recommend that patients hospitalized for heart failure receive outpatient follow-up for 7 to 14 days after discharge.

Alabama is the 6th poorest state in the United States, but the 3rd most populous state. Diagnosed with type 2 diabetes. The state also has the highest rate of hospitalization for heart failure and the highest mortality rate from cardiovascular disease in the nation. Previous studies have shown that obesity and type 2 diabetes are among the risk factors for heart failure, disproportionately affecting people of lower socioeconomic status and increasing the risk of heart failure.

The study’s findings “are likely indicative of system-related factors, such as problems in the transition of care between hospitals and clinics, and systemic racism that exists in the healthcare system,” said the study’s lead author. said Yulia Hodneva, M.D. , Assistant Professor of Medicine and Primary Care Physician at the University of Alabama School of Medicine, Birmingham.

“This study highlights the need to develop interventions that promote guideline-based treatment and care for people with type 2 diabetes and heart failure, especially Medicaid recipients and people of underrepresented races and ethnicities. there is,” she said.

Analysis revealed that most follow-up visits far exceeded the standard of care prescribed by guidelines.

• Thirty-one percent were seen between 3 weeks and up to 2 months after discharge.
• Nearly 27% did not see a doctor during the 60-day study observation period.and
• People who do not seek medical attention within 60 days of being discharged from the hospital are generally more likely to be male, African-American adults, Hispanic or other adults.

We hope that this study will provoke additional, more in-depth studies to explain the reasons for the observed racial disparities and help develop interventions that facilitate rapid follow-up of these patients. “

Yulia Khodneva, MD, Ph.D., Assistant Professor and Primary Care Physician, University of Alabama School of Medicine

The study was conducted in Alabama, so the results may not apply to other US states. Additionally, the study did not include people without Medicaid or commercial insurance plans for comparison.

Study design:

• The researchers found that between 2010 and 2019, more than 9,800 adults with first-time hospitalization for type 2 diabetes and heart failure (mean age, 53 years; 65% females, 35% males) were eligible for Alabama Medicaid. reviewed the data.
• More than 47% of those analyzed were African American adults. Approximately 42% were non-Hispanic white adults. And 11% were categorized as Hispanic, Asian, Native American, and Pacific Islander adults. Racial identification was based on self-reported information submitted by patients to Medicaid.
• Nearly 20% of participants live in rural areas and over 80% live in urban areas or small towns. Disability was the reason for Medicaid eligibility in 92% of cases.
• Researchers analyzed Medicaid claims for clinic visits for primary care and follow-up care, such as cardiology and endocrinology, within 60 days after hospital discharge.

Co-authors and author disclosures are provided in the manuscript. This study was funded by the National Institute of Diabetes, Digestive and Kidney Diseases, a division of the National Institutes of Health. University of Alabama (UAB) Diabetes Research Center. UAB COVID-19 Care-Affected Young Investigator Retention Program. and Forge Ahead Center.