ABSTRACT
PURPOSE: To examine the effect of a follow-up visit with a primary care physician and/or pulmonologist within the first 30 days of hospital discharge on readmissions, emergency department (ED) visits, and mortality. PATIENTS AND METHODS: This was a retrospective cohort study of 7,102 unique patients discharged from a Mayo Clinic hospital in Rochester, MN, and residing in Olmsted County, MN, with any mention of chronic obstructive pulmonary disease (COPD) from January 1, 2004 through November 30, 2011. The study included 839 patients who met study-entry criteria. Cox proportional hazards regression was performed to determine the risk of hospital readmission, ED visits, and death of patients, with or without a follow-up visit during the first 30 days postdischarge. RESULTS: Our results showed 839 unique patients experienced 1,422 discharges with a primary diagnosis of COPD. Of the 1,422 discharges, 973 (68.4%) had a follow-up visit within 30 days. In a multivariate Cox proportional hazard-ratio (HR) model analysis, occurrence of a follow-up visit did not have a significant effect on the risk of the combined outcome of 30-day readmission and ED visit (HR 0.947, confidence interval 0.763-1.177; P=0.63). However, a postdischarge follow-up visit had a significant effect on 30-day mortality (HR 0.279, confidence interval 0.149-0.523; P<0.001). CONCLUSION: Postdischarge follow-up visits after hospitalization for COPD did not significantly reduce the risk of 30-day readmission or ED visit. However, patients who received postdischarge follow-up visits had significantly reduced 30-day mortality.
ABSTRACT
Case reports have documented reversible cardiac dysfunction in the setting of severely depressed extracellular calcium concentrations. The present systematic review and meta-analyses of individual patient data were conducted to further characterize the cardiac dysfunction associated with low serum calcium levels in the clinical setting. We searched Ovid MEDLINE, Embase, PubMed databases and the Cochrane Library and the Registry of Clinical Trials from 1948 through August 2011. Studies that evaluated low serum calcium and cardiac dysfunction were identified and included for review. A total of 43 studies comprised of 47 individual cases met inclusion criteria. Univariate linear regression analysis showed a statistically significant correlation between corrected QT interval (QTc) length and corrected total serum calcium level (B = -23.19, SE = 8.04, P = 0.01), left ventricular ejection fraction and corrected total serum calcium (B = 5.16, SE = 1.29, P < 0.01) and ionized serum calcium (B = 5.48, SE = 2.04, P = 0.03). Hypocalcemia may be associated with reversible cardiac dysfunction including QTc interval prolongation and depressed left ventricular systolic function. The available evidence is very limited and does not provide a rationale for a certain threshold or a recommendation for calcium replacement. Future research is needed in this important and common metabolic disorder.
