Early post-discharge follow-up in acute heart failure: attendance, barriers, and outcomes in the AHF-ImmunoCS Study
C S Schuele, D P Pelin, M B Bauser, B A Afshar, G G Gueder, M H Hanke, F K Kerwagen, T K Kerkau, U H Hofmann, S F Frantz, N B Beyersdorf, S S Stoerk, C M MorbachAbstract
Background
Current guidelines recommend a follow-up visit (FUP) within 1-2 weeks after a heart failure (HF) hospitalization. However, implementing this early post-discharge pathway in routine practice is challenging. We evaluated early follow-up attendance after acute heart failure (AHF) hospitalization and investigated reasons for non-attendance under maximally supportive conditions.
Methods
AHF–ImmunoCS is an ongoing prospective cohort study enrolling consecutive patients hospitalized for AHF. All participants are scheduled for a 6-week post-discharge follow-up outpatient visit including blood sampling and optimized guideline-directed care. Study staff provides extensive support to facilitate attendance (transport arrangements, telephone reminders, logistical assistance); reasons for non-attendance are documented. Patients who died within 6 weeks after inclusion were excluded from analysis. Adverse events (HF rehospitalization and death) were assessed at 180 days. Outcome analysis was done using Kaplan-Meier plots and Cox proportional hazards regression adjusted for age and sex.
Results
Between 03/2022 and 02/2025, 380 patients were included: mean age 72±12 years, 33% women, 39% de novo HF, 86% in NYHA classes III/IV, median NT-proBNP 4518 pg/ml (quartiles: 2274-10964 pg/ml). Of those, 12 (3%) died within six weeks after study inclusion (excluded from analysis). 294 (80%) attended the 6-week follow-up visit in person, while 74 (20%) did not. Reasons for non-attendance included rehospitalization or rehabilitation (53%), non-compliance (16%), unspecified (12%), frailty (11%), palliative care (5%), and caregiver duties (3%). Non-attendees tended to have more severe HF at baseline (NYHA class III/IV 91% vs 84%; de novo HF 47% vs 37%), though not statistically significant. Baseline etiology, NT-proBNP, and LVEF were similar between the two groups. At 180 days, non-attendees had higher rates of HF rehospitalization (35% vs. 20%; p = 0.032) and a higher proportion of mortality due to HF (11% vs 2%, p=0.003) compared to attendees, although all-cause mortality between the two groups did not differ significantly (11% vs 7%). In an age- and sex-adjusted Cox proportional hazards model, non-attendance was associated with a significantly higher risk of HF rehospitalization or death (HR 1.88, 95% CI 1.24–2.86, p = 0.003).
Conclusion
Even with optimal support, a substantial proportion of AHF patients did not attend the early post-discharge visit. Reasons for non-attendance often reflected greater disease severity (e.g. rehospitalization) and non-attendance was associated with higher HF rehospitalization rates and increased risk of cardiovascular death. Adaptive follow-up strategies for this vulnerable population could include remote patient and home-care support to ensure continuity of care after an AHF hospitalization.For image description, please refer to the figure legend and surrounding text.