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We thank Dr Ezekowitz and McAlister for their interest in our work on early outpatient follow-up after a hospitalization for heart failure.1 The investigators raise an interesting question: what proportion of early follow-up appointments was planned to be with a familiar provider? A prior analysis from their group identified an association between provider continuity and improved outcomes after a hospitalization for heart failure in Canada.2 However, whether these findings extend to other settings, including the United States, are unknown. For example, in a prior analysis of Medicare beneficiaries hospitalized with heart failure, early follow-up with a physician from the index hospitalization was not associated with 30-day readmission rates.3The question posed by these authors raises a larger issue. What are the unintended consequences, or “off-target effects,” of early follow-up? Certainly, there are financial implications for increased clinic appointments after a heart failure hospitalization, though these are presumably offset by reduced hospitalizations. Could early follow-up …

circulation. heart failure

Response to Letter Regarding Article, “Temporal Trends and Variation in Early Scheduled Follow-up After a Hospitalization for Heart Failure: Findings from Get With The Guidelines-Heart Failure