Early Follow-Up After a Heart Failure Exacerbation
Why this work is in the frame
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Bibliographic record
Abstract
BACKGROUND: Although early follow-up for heart failure (HF) is recommended, the time window and which physicians should do the follow-up are unclear. We explored whether (1) follow-up within 14 days and (2) physician continuity influence outcomes within 30 days of a HF exacerbation. METHODS AND RESULTS: Retrospective cohort of all adults in Alberta, Canada, with a first discharge from a hospital or an emergency department where HF was the most responsible diagnosis between April 2002 and November 2013, analyzed using Cox proportional hazards models with time-varying covariates. Of 39 249 adults (mean age,76.1 years), 21 848 (55.7%) received follow-up from a familiar physician, 3938 (10.0%) saw an unfamiliar physician, and 13 463 (34.3%) had no outpatient visits in the first 14 days after a hospitalization or emergency department visit for HF. The risk of death or hospitalization within 30 days was lower in patients who saw a familiar physician (16.9%; adjusted hazard ratio [aHR],0.94;95%confidence interval [CI],0.89-0.99) than inthose who sawan unfamiliar physician (20.0%;aHR,1.05;95%CI,0.97-1.15) or those with no outpatient visits (22.0%;aHR,1.00 [referent]). The composite of death or emergency department visit or hospitalization within 30 days was also less common with familiar physician follow-up (25.2%;aHR,0.86;95%CI,0.82-0.89) compared withunfamiliar physicians (26.9%;aHR,0.93;95%CI,0.87-0.996) or those with no outpatient follow-up within 14 days (47.5%;aHR,1.00 [referent]). CONCLUSIONS: Outpatient follow-up within 14 days after HF exacerbation requiring hospitalization or emergency department visit is associated with better outcomes, particularly if the follow-up is with a familiar physician.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it