Older Medicare beneficiaries who do not receive timely follow-up care after hospital discharge for systemic lupus erythematosus have a higher likelihood of death, new data suggest.
In a 2014 Medicare sample including 8606 lupus-related hospitalizations (5403 patients), 35.5% lacked follow-up with a primary care physician or rheumatologist within 30 days of discharge, Christie M. Bartels, MD, MS, of the University of Wisconsin, Madison, and colleagues reported in Arthritis Care & Research. A total of 38.6% of lupus-related hospitalizations involved adults aged 65 years and older. Follow-up was significantly associated with a 65% lower risk of mortality in this older age group. The death rate was 0.7% vs 3.9% among older adults who did and did not have follow-up visits, respectively.
Older adults who did receive timely follow-up with their primary care physician or rheumatologist had a significant 27% greater likelihood of receiving receive acute care, including an emergency department visit or additional hospital stay, compared with those who did not follow up. The investigators were unable to account for lupus severity, duration, or treatments. They observed no significant association with acute care or death among patients aged 18-64 years.
Medicare beneficiaries with kidney failure, who accounted for 39.2% of lupus hospitalizations, had significant 31% decreased odds of follow-up with a primary care physician or rheumatologist within 30 days of hospital discharge. The study did not capture visits with nephrologists. Rural residence was significantly associated with 30% decreased odds of follow-up compared with suburban residence.
“The results indicate a need for better ambulatory access or outreach to lupus patients, particularly those residing in rural and disadvantaged neighborhoods,” according to Dr Bartels’ team.
Schletzbaum M, Sweet N, Astor B, et al. Associations of postdischarge follow-up with acute care and mortality in lupus: a Medicare cohort study. Arthritis Care Res. Published online February 8, 2023. doi:10.1002/acr.25097