Research Highlights:
Embargoed until 4 a.m. CT/5 a.m. ET Wednesday, June 7, 2023
DALLAS, June 7, 2023 — More than half of Medicaid-covered adults in Alabama with Type 2 diabetes did not receive follow-up health care within the recommended two-week period following hospitalization for newly-diagnosed heart failure , according to new research. The analysis, published today in the Journal of the American Heart Association , an open access, peer-reviewed journal of the American Heart Association, found worse follow up for African American and Hispanic adults.
The large, racially diverse study also found that African American adults and Hispanic adults were less likely to see a primary care doctor after leaving the hospital compared to similar white adults. When African American adults and Hispanic adults had a follow-up visit, it was about two to three days later than their white peers.
People with Type 2 diabetes are at increased risk of developing heart failure requiring hospitalization. The American Heart Association’s guidelines recommend patients hospitalized with heart failure have outpatient follow-up 7-14 days after leaving the hospital.
Alabama, the sixth poorest state in the U.S., is also home to the third-highest number of people diagnosed with Type 2 diabetes. The state also has the highest rates of heart failure hospitalizations and cardiovascular death in the country. Obesity and Type 2 diabetes are among the risk factors for heart failure and disproportionally affect people with low socioeconomic status, which increases the risk for heart failure, according to previous studies.
The study’s findings “likely demonstrates system-related factors, such as problems in the transitions of care between hospitals and clinics, and also structural racism that exists in the health care system,” said lead study author Yulia Khodneva, M.D, Ph.D., an assistant professor of medicine and primary care physician at the University of Alabama School of Medicine in Birmingham.
“The study underscores a necessity to develop interventions that will facilitate guideline-directed treatment and care for patients with Type 2 diabetes and heart failure, especially for those with Medicaid or people of underrepresented races and ethnicities,” she said.
The analysis found most follow-up visits were well beyond the guideline-stated standard of care:
“Hopefully, this study will trigger additional, more in-depth studies that may help to explain the reasons for these observed racial disparities and help in the development of interventions to promote prompt follow-up for these patients,” Khodneva said.
Because the study was conducted in Alabama, the results may not be applicable to other U.S. states. Additionally, the research did not include people without Medicaid coverage or commercial insurance plans for comparison.
Study design:
Co-authors and authors’ disclosures are listed in the manuscript. The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases, a division of the National Institutes of Health; the University of Alabama (UAB) Diabetes Research Center; the UAB COVID-19 Caregiving Affected Early-career Research Scientists Retention Program; and the Forge Ahead Center.
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Journal of the American Heart Association
Disparities in Postdischarge Ambulatory Care Follow-Up Among Medicaid Beneficiaries With Diabetes, Hospitalized for Heart Failure