Heart Failure In France Research Articles

PRADOC: A Multicenter Randomized Controlled Trial to Assess the Efficiency of PRADO-IC, a Nationwide Pragmatic Transition Care Management Plan for Hospitalized Patients With Heart Failure in France.

The PRADO-IC (Programme de Retour à Domicile après une Insuffisance Cardiaque) is a transition care program designed to improve the coordination of care between hospital and home that was generalized in France in 2014. The PRADO-IC consists of an administrative assistant who visits patients during hospitalization to schedule follow-up visits. The aim of the present study was to evaluate the PRADO-IC program based on the hypotheses provided by health authorities. The PRADOC study is a multicenter, controlled, randomized, open-label, mixed-method trial of the transition program PRADO-IC versus usual management in patients hospitalized with heart failure (standard of care group; NCT03396081). A total of 404 patients were recruited between April 2018 and May 2021. The mean patient age was 75 years (±12 years) in both groups. The 2 groups were well balanced regarding severity indices. At discharge, patients homogeneously received the recommended drugs. There was no difference between groups regarding hospitalizations for acute heart failure at 1 year, with 24.60% in the standard of care group and 25.40% in the PRADO-IC group during the year following the index hospitalization (hazard ratio, 1.04 [95% CI, 0.69-1.56]; P=0.85) or cardiovascular mortality (hazard ratio, 0.67 [95% CI, 0.34-1.31]; P=0.24). The PRADO-IC has not significantly improved clinical outcomes, though a trend toward reduced cardiovascular mortality is evident. These results will help in understanding how transitional care programs remain to be integrated in pathways of current patients, including telemonitoring, and to better tailor individualized approaches. URL: https://www.clinicaltrials.gov; Unique Identifier: NCT03396081.

Cardiovascular disease healthcare trajectories: descriptions, similarities, mortality rates of heart failure in France.

The primary objectives of this study were to analyse the nationwide healthcare trajectories of heart failure (HF) patients in France, 2years after their first hospitalization, and to measure sequence similarities. Secondary objectives were to identify the association between trajectories and the risk of mortality. A retrospective, observational study was conducted using data extracted from the Echantillon Généraliste des Bénéficiaires database, covering the period from 1 January 2008 to 31 December 2018. Follow-up concluded upon death or at the end of the study. We developed a methodology specific to healthcare data by extracting frequent healthcare trajectories and measuring their similarity for use in a survival machine learning analysis. In total, 11488 HF patients were included and followed up for an average of 2.9±1.3years. The mean age of the patients was 78.0±13.2years. The first-year mortality rate was 31.7% and increased to 78.8% at 5years. Fifty per cent of patients experienced re-hospitalization for reasons related to cardiovascular diseases. We identified 1707 hospitalization sequences, and 21 sequences were associated with survival, while 15 sequences were linked to mortality. In all our models, age and gender emerged as the most significant predictors of mortality (permutation feature importance: 0.099±0.00078 and 0.0087±0.00018, respectively; weights could be interpreted in relative terms). Specifically, the age at initial hospitalization for HF was positively associated with mortality. Gender (male: 49.5%) was associated with poorer prognoses. Healthcare trajectories, including non-surgical device treatments, valve replacements, and atrial fibrillation ablation, were associated with a better prognosis (permutation feature importance: 0.0047±0.00011, 0.0014±0.000073, and 0.00095±0.000097, respectively), except in cases where these invasive treatments preceded or followed hospitalization for cardiac decompensation. The predominant negative prognosis sequences were mostly those that included HF-related hospitalizations before or after other-related hospitalizations (permutation feature importance: 0.0007±0.000091 and 0.00011±0.000045, respectively). We highlight the value of healthcare trajectories on frequent hospitalization sequences, mortality, and prognosis and indicate the necessary prognostic value of HF re-hospitalization. Our work may be an essential tool for better identification of at-risk patients in order to increase and improve personalized care in the future.

Hospital Resource Utilization and Costs in Patients with Heart Failure in France.

Heart failure (HF) is one of the leading causes of morbidity and mortality, and economic burden on the healthcare system. The aim of this study was to estimate the current hospital resource utilization and costs for HF patients in France. This retrospective cohort study included adult HF patients hospitalized in France between January 1, 2019 and December 31, 2019. Data related to sociodemographic characteristics, number and duration of hospital stays, use of medical procedures or expensive and innovativedrugs/medical devices included in the "liste-en-sus", and comorbidities were retrieved from the French national hospital discharge database. Data were further stratified based on the presence or absence of cardiac decompensation, comorbidities, ejection fraction (EF) status, and incident/prevalent patients. In 2019, a total of 430,544 patients were hospitalized in France with HF as a primary or associated diagnosis, with 51.9% male and 48.1% female and a mean age of 79.0years. More than 75% of the study population was composed of prevalent HF patients. About 3.1% of patients were diagnosed with at least one event of cardiac decompensation during follow-up. Also, 20.2% and 9.9% of patients were identified with preserved and reduced EFs, respectively. The average number and length of hospital stays were 1.7 per patient and 10.4 days per patient, respectively. The annual cost of hospitalization for HF was €8341.3 per patient. Presence of cardiac decompensation at index date or during follow-up, reduced EF, and comorbidities were associated with numerically higher frequency and length of hospitalization, and hospitalization cost. For hospitalization and 'liste-en-sus' medical devices, higher cost was observed in incident than prevalent HF patients, while for 'liste-en-sus' drugs, higher cost was reported in prevalent than incident HF patients. This study highlighted the high economic hospital burden of HF in France. More studies investigating different HF patient profiles must be conducted to help determine the main factors of hospital cost for HF.

A telemonitoring programme in patients with heart failure in France: a cost-utility analysis

BackgroundCertain telemedicine programmes for heart failure (HF) have been shown to reduce all-cause mortality and heart failure-related hospitalisations, but their cost-effectiveness remains controversial. The SCAD programme is a home-based interactive telemonitoring service for HF, which is one of the largest and longest-running telemonitoring programmes for HF in France. The objective of this cost-utility analysis was to evaluate the cost-effectiveness of the SCAD programme with respect to standard hospital-based care in patients with HF.MethodsA Markov model simulating hospitalisations and mortality in patients with HF was constructed to estimate outcomes and costs. The model included six distinct health states (three ‘not hospitalised’ states, two ‘hospitalisation for heart failure’ states, both depending on the number of previous hospitalisations, and one death state). The model lifetime in the base case was 10 years. Model inputs were based on published literature. Outputs (costs and QALYs) were compared between SCAD participants and standard care. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty in the input parameters of the model.ResultsThe number of quality-adjusted life years (QALYs) was 3.75 in the standard care setting and 4.41 in the SCAD setting. This corresponds to a gain in QALYs provided by the SCAD programme of 0.65 over the 10 years lifetime of the model. The estimated total cost was €30,932 in the standard care setting and €35,177 in the SCAD setting, with an incremental cost of €4245. The incremental cost-effectiveness ratio (ICER) for the SCAD programme over standard care was estimated at €4579/QALY. In the deterministic sensitivity analysis, the variables that had the most impact on the ICER were HF management costs. The likelihood of the SCAD programme being considered cost-effective was 90% at a willingness-to-pay threshold of €11,800.ConclusionsEnrolment of patients into the SCAD programme is highly cost-effective. Extension of the programme to other hospitals and more patients would have a limited budget impact but provide important clinical benefits. This finding should also be taken into account in new public health policies aimed at encouraging a shift from inpatient to ambulatory care.

Remote patient monitoring for chronic heart failure in France: When an innovative funding program (ETAPES) meets an innovative solution (Satelia® Cardio).

IntroductionRemote patient monitoring (RPM) is a telehealth activity to collect and analyze patient health or medical data. Its use has expanded in the past decade and has improved medical outcomes and care management of non-communicable chronic diseases. However, implementation of RPM into routine clinical activities has been limited. The objective of this study was to describe the French funding program for RPM (known as ETAPES) and one of the RPM solution providers (Satelia®) dedicated to chronic heart failure (CHF).MethodsA descriptive assessment of both the ETAPES funding program and Satelia® RPM solution was conducted. Data were collected from official legal documents and information that was publicly available online from the French Ministry of Health.Results and DiscussionETAPES was formally created in 2016 based on previous legislation pertaining to the national health insurance funding strategy. However, it only started to operate in 2018. Patients with CHF were only eligible if they were at medium or high risk of re-hospitalization with a New York Heart Association (NYHA) score superior or equal to two and a BNP>100 pg/ml or NT pro BNP>1000 pg/ml. Medical monitoring was supported through the therapeutic education of a patient on the RPM model of care with a minimum of three training sessions during the first six months. The use of Satelia® Cardio is noteworthy since it relies only on symptomatic monitoring through which the patient manually reports their information by answering a simple questionnaire on a regular basis and does not rely on any connected devices.ConclusionInnovative funding programs and solutions for RPM need real-world evaluation in the future.

Intérêt et avenir de la télésurveillance dans l'insuffisance cardiaque chronique

Chronic heart failure in France is responsible for 160 000 hospitalizations per year. The treatment of chronic heart failure is multidisciplinary.Telemedicine (TLM) reinforces the therapeutic arsenal of this chronic pathology by the use of remote monitoring (TLS) on patients followed outside the care structure. This paradigm has proven its effectiveness with the help of digital networks and specific algorithms, which communicate through connected tools with the ICC patient. Clinical signs of worsening can trigger an alert that will be taken into account by the TLS. Early intervention on these warning signs avoids acute decompensation and a new hospitalization of the patient. The analysis of the results shows a rate of alerts that require the intervention of TLS teams, from 20 to 35% depending on the centers. The ETAPES program has set the regulatory framework for the TLS experiment for 4 years. It will end at the end of 2021. The feedback from the TLS centers is between 6 and 18 months. The satisfaction index of patients followed by TLS is 95%.The intermediate results (2018, 2019) and the evaluation of the ETAPES program, are in favor of TLS management of ICC patients. Therapeutic education and TLS improve patients' quality of life. The Ministry of Health plans a transition to the common law for TLS in 2022.

First experience with a ready to use solution for remote monitoring of patients suffering from heart failure in France

Heart failure (HF) is associated with a high mortality rate and recurrent hospitalizations. To present the first data of the patients using the innovative solution Satelia® Cardio (NP Medical/WeHealth™ Digital Medicine). Satelia® Cardio is a HF patient management solution with a remote monitoring system and a therapeutic guidance by dedicated nurse phone platform, supported by ETAPES Program. The system is accessible from any devices, requiring no installation, and the use is possible by non-connected patients. After the inclusion, the patient is contacted by the nurse, he then receives an SMS alert on regular basis, with a link leading to a web page to answer 7 questions, and to give his current body weight. Satelia algorithm is based on this signs,their variability, and the weight. In case of worsening of symptoms, the cardiologist will be notified. 124 centers (200 cardiologists) are using Satelia® Cardio with 1832 HF patients monitored in the last 18 months. The patients, mean age of 72 years (19-97) are predominantly males (69%), and mostly NYHA II/III (68%/30%). The adherence to the system is very good (81%) with 86% of patients still monitored (N = 1569). The main reasons for stopping are related to the occurrence of death (105/263) or non-fatal events (71/263), or patient decision (87/263). Over the period of analysis, the HF patients answered to 46 637 questionnaires, generating 2429 alerts transmitted to the referent cardiologists. Since Covid-19 lockdown, more than 600 patients have been monitored with the solution. Patient management solution with a remote monitoring system is key to improving the follow-up of HF patients. The solution Satelia® Cardio is an easy way to use a web application to monitor HF patients, accepted by the patients with a low rate of premature discontinuation. A further step will be to initiate studies to assess the clinical impact of such remote monitoring solution in HF.

PRADOC: a trial on the efficiency of a transition care management plan for hospitalized patients with heart failure in France.

AimsTransition care programmes are designed to improve coordination of care between hospital and home. For heart failure patients, meta‐analyses show a high efficacy but with moderate evidence level. Moreover, difficulties for implementation of such programmes limit their extrapolation.Methods and resultsWe designed a mixed‐method study to assess the implementation of the PRADO‐IC, a nationwide transition programme that aims to be offered to every patient with heart failure in France. This programme consists essentially in an administrative assistance to schedule follow‐up visits and in a nurse follow‐up during 2 to 6 months and aims to reduce the annual heart failure readmission rate by 30%. This study assessed three quantitative aims: the cost to avoid a readmission for heart failure within 1 year (primary aim, intended sample size 404 patients), clinical care pathways, and system economic outcomes; and two qualitative aims: perceived problems and benefits of the PRADO‐IC. All analyses will be gathered at the end of study for a joint interpretation. Strengths of this study design are the randomized controlled design, the population included in six centres with low motivation bias, the primary efficiency analysis, the secondary efficacy analyses on care pathway and clinical outcomes, and the joint qualitative analysis. Limits are the heterogeneity of centres and of intervention in a control group and parallel development of other new therapeutic interventions in this field.ConclusionsThe results of this study may help decision‐makers to support an administratively managed transition programme.

PCV84 Patient Pathway in Heart Failure in France

Objectives: HF is one of the leading causes of hospitalization in France for patients above 65 years old and represented a cost of 2 3 billion for the national health insurance in 2017 The objective is to describe heart failure (HF) patient pathway and identify breaking points that could be improved in France Methods: Descriptions were based on a literature review and qualitative interviews conducted with different stakeholders including cardiologists, geriatrician, general practitioners, nurses, pharmacists, patient associations and regional health agencies Results: The management and coordination of the patient's care pathway is complex and burdened with frequent and prolonged rehospitalizations Multiple breaking points have been identified in the patient pathway as a late therapeutic management of symptoms, a therapeutic inertia, scarce medical and paramedical resources limiting their ability to get involved in therapeutic education or a too narrow link between inpatient hospitalizations and outpatient settings to ensure a strong continuity of care Different solutions have been implemented nationally or locally to improve the pathway by promoting the use of telemedicine, smart scale or optimizing therapeutic education for HF patients Although telemedicine has not had the success story it had hoped until recently, it seems that the COVID-19 has enable the rise of digital health solutions considered as an innovative and necessary alternative Conclusions: While the economic and clinical burden of HF continue to increase it is important to improve the care pathway in order to reduce the risk of re-hospitalizations and the associated costs Digital solutions including e-health and telemedicine could enable to improve the patient pathway

Epidemiological characteristics and therapeutic management of patients with chronic heart failure who use smartphones: Potential impact of a dedicated smartphone application (report from the OFICSel study)

The effectiveness of transitional care services for patients discharged from hospital after acute heart failure is challenging, especially in terms of reducing subsequent heart failure hospitalizations. The increased adoption of smartphone applications in society offers a new opportunity to interact with patients to avoid rehospitalization. Thus, electronic health (e-health) can enhance the impact of existing therapeutic education programmes. To determine the prevalence of smartphone use among patients with chronic heart failure, and to assess the epidemiological characteristics and therapeutic management of these patients, with a broader aim of developing smartphone-based therapeutic education programmes for patients. The French Observatoire français de l'insuffisance cardiaque et du sel (OFICSel) registry was conducted in 2017 by 300 cardiologists, and included both inpatients and outpatients who had been hospitalized for heart failure at least once in the previous 5 years. Data collection included demographic and heart failure-related variables, which were provided by the cardiologist and by the patient via a questionnaire. Among the 2822 patients included, 2517 completed the questionnaire. Of this total, 907 patients (36%) were smartphone users. Compared with non-users, smartphone users were younger, were more frequently men, more frequently lived in cities, had a higher educational level and were more frequently professionally active. Smartphone users less frequently had diabetes, hypertension, atrial fibrillation or ischaemic cardiopathy. Only 22% of patients were actively participating in a therapeutic education programme. Smartphones were used by more than one-third of patients with heart failure in France in 2017, underscoring the feasibility of developing a smartphone application to deliver therapeutic education to the population with chronic heart failure.

Outpatient health care 30 days after hospitalization for heart failure in France: Contribution of the national health datasystem (SNDS)

Recommendations for heart failure (HF) outpatient follow-up have been published. The SNDS offers the opportunity to confront them to real-life, including geographical disparities. Moreover, estimation variation has to be explored when population excludes institutionalized patients (IP) that have specific healthcare use and refund: rehabilitation (SSR), psychiatric hospitalization (psy), skilled nursing home (EHPAD) which is not usually done. To study outpatient healthcare use variations in France after hospitalization for HF, using SNDS data. The first stay for HF (> 0 days) in 2015 of patients over 18 y.o. covered by the general scheme (RG/SLM 88% of population) was considered. Healthcare use 30 days after was compared with (RG/SLM) or without IP (RG/SLM eIP). Regional outpatient care use rates were standardized by age and sex. Among 104 984 alive patients 30 days after HF hospitalization (RG/SLM, female 52%, mean age 79 y.o.), 16% stayed in SSR, 9% in cardiologic SSR, 12% in EHPAD, 0.2% in psy and 75% returning home and not institutionalized (RG/SLM eIP; n = 70367). Among all RG/SLM patients vs RG/SLM eIP (mean age 79 y.o. vs. 78 y.o.), a cardiologist was seen at least once in 30 days post hospitalization 20% vs. 21% (median delay 14 days IQR 7-23 vs. 16 IQR 9-24), a general practitioner 69% vs. 78% (8 IQR 3-16 vs. 7 IQR 3-15), a nurse 58% vs. 69% (3 IQR 1-9 vs. 2 IQR 1-7). ACE inhibitors were reimbursed at least once for 34% vs. 39%, ARBs 14% vs. 17%, and diuretics 69% vs. 77%. Among RG/SLM eIP patients, departmental disparities were high: cardiologist (3% to 46%), GP (59% to 93%), nurse visit (49% to 82%). Lower rates for GP were found in the center of France but with higher rates for nurse visits. We recommend using RG/SLM eIP when studying outpatient healthcare use in the SNDS. Low visit rates and high delays regarding the recommendations point out the need of a multidisciplinary community health care in France.

Outpatient health care 30 days after hospitalization for heart failure in France

Abstract Background Recommendations for heart failure (HF) outpatient follow-up have been published. The SNDS offers the opportunity to confront them to real-life, including geographical disparities. Moreover, estimation variation has to be explored when population excludes institutionalized patients (IP) that have specific healthcare use and refund: rehabilitation (SSR), psychiatric hospitalization (psy), skilled nursing home (EHPAD) which is not usually done.The Purpose is to study outpatient healthcare use variations in France after hospitalization for HF, using SNDS data. Methods The first stay for HF (>0days) in 2015 of patients over 18 yo covered by the general scheme (RG/SLM 88% of population) was considered. Healthcare use 30 days after was compared with (RG/SLM) or without IP (RG/SLM eIP). Regional outpatient care use rates were standardized by age and sex. Results Among 104 984 alive patients 30 days after HF hospitalization (RG/SLM, female 52%, mean age 79 yo), 16% stayed in SSR, 9% in cardiologic SSR, 12% in EHPAD, 0.2% in psy and 75% returning home and not institutionalized (RG/SLM eIP; n = 70367). Among all RG/SLM patients vs RG/SLM eIP (mean age 79 yo vs 78 yo), a cardiologist was seen at least once in 30 days post hospitalization 20% vs 21% (median delay 14 days IQR 7-23 vs 16 IQR 9-24), a general practitioner 69% vs 78% (8 IQR 3-16 vs 7 IQR 3-15), a nurse 58% vs 69% (3 IQR 1-9 vs 2 IQR 1-7). ACE inhibitors were reimbursed at least once for 34% vs 39%, ARBs 14% vs 17%, and diuretics 69% vs 77%. Among RG/SLM eIP patients, departmental disparities were high: cardiologist (3% to 46%), GP (59% to 93%), nurse visit (49% to 82%). Lower rates for GP were found in the center of France but with higher rates for nurse visits. Conclusions We recommend using RG/SLM eIP when studying outpatient healthcare use in the SNDS. Low visit rates and high delays regarding the recommendations point out the need of a multidisciplinary community health care in France. Key messages Low visit rates and high delays regarding the recommendations point out the need of a multidisciplinary community health care in France. We recommend using RG/SLM eIP when studying outpatient healthcare use in the SNDS.

Impact of early primary care follow-up after discharge on hospital readmissions.

Reducing repeated hospitalizations of patients with chronic conditions is a policy objective for improving system efficiency. We test the hypothesis that the risk of readmission is associated with the timing and intensity of primary care follow-up after discharge, focusing on patients hospitalized for heart failure in France. We propose a discrete-time model which takes into account that primary care treatments have a lagged and cumulative effect on readmission risk, and an instrumental variable approach,exploiting geographical differences in availability of generalists. We show that the early consultations with a GP after discharge can reduce the 28-day readmission risk by almost 50%, and that patients with higher ambulatory care utilization have smaller odds of readmission. Furthermore, geographical disparities in primary care affect indirectly the readmission risk. These results suggest that interventions which strengthen communication between hospitals and generalists are elemental for reducing readmissions and for developing effective strategies at the hospital level, it is also necessary to consider primary care resources that are available to patients.

Admissions to intensive cardiac care units in France in 2014

Geographic variation in admission to the intensive cardiac care unit (ICCU) might question about the efficiency and the equity of the healthcare system. The aim was to explain geographic variation in the rate of admission to ICCU for coronary artery disease (CAD) or heart failure (HF) in France.We conducted a retrospective study based on the French national hospital discharge database. All inpatient stays for CAD or HF with an admission to an ICCU in 2014 were included. We estimated population-based age and sex-standardized ICCU admission rates at the department level. We separately modeled the department-level admission rates for HF and CAD using generalized linear models.In all, 61,010 stays for CAD and 27,828 stays for HF had at least 1 ICCU admission. The ICCU admission rates were explained by the admission rate for CAD, by the diabetes prevalence, by the proportion of the population >75 years, and by the drive time to the ICCU.This work sheds light on the finding of substantial geographic variation in the ICCU admission rates for CAD and HF in France. This variation is explained by both the age and the health status of the population and also by the drive time to the closest ICCU for HF. Moreover, ICCU admission for HF might be more prone to unwarranted variations due to medical practice patterns.

Management of acute heart failure: Contribution of daily bedside echocardiographic assessment on therapy adjustment with impact measure on the 30-day readmission rate (JECICA).

There are currently one million heart failure (HF) patients in France and the rate is progressively increases due to population aging. Acute decompensation of HF is the leading cause of hospitalization in people over 65 years of age with a 25% re-hospitalization rate in the first month. Expenses related to the management of HF in France in 2013 amounted to more than one billion euros, of which 65% were for hospitalizations alone. The management of acute decompensation is a challenge, due to the complexity of clinical and laboratory evaluation leading to therapeutic errors, which in turn leads to longer hospitalization, high early re-hospitalization and complications. Therapeutic adjustment, especially diuretic, in the acute phase (during hospitalization) affects early re-hospitalization rates (within 30 days). These adjustments can be based on clinical estimation and laboratory parameters, but echocardiography has been shown to be superior in estimating filling pressures (FP) compared to clinical and laboratory parameters.We hypothesize that a simple daily bedside echocardiographic assessment could provide a reproducible estimation of FP with an evaluation of mitral inflow and the inferior vena cava (IVC). This could allow a more reliable estimate of the true blood volume of the patient and thus lead to a more suitable therapeutic adjustment. This in turn should lead to a decrease in early re-admission rate (primary endpoint) and potentially decrease six-month mortality and rate of complications.

PCV57 - Costs of Acute Heart Failure in France

PCV57 - Costs of Acute Heart Failure in France

First hospitalization for heart failure in France in 2009: Patient characteristics and 30-day follow-up

The incidence of heart failure (HF) is stable in industrialized countries, but its prevalence continues to increase, especially due to the ageing of the population, and mortality remains high. To estimate the incidence in France and describe the management and short-term outcome of patients hospitalized for HF for the first time. The study population comprised French national health insurance general scheme beneficiaries (77% of the French population) hospitalized in 2009 with a principal diagnosis of HF after exclusion of those hospitalized for HF between 2006 and 2008 or with a chronic disease status for HF. Data were collected from the national health insurance information system (SNIIRAM). A total of 69,958 patients (mean age 78 years; 48% men) were included. The incidence of first hospitalization for HF was 0.14% (≥ 55 years, 0.5%; ≥ 90 years, 3.1%). Compared with controls without HF, patients more frequently presented cardiovascular or other co-morbidities. The hospital mortality rate was 6.4% and the mortality rate during the 30 days after discharge was 4.4% (3.4% without readmission). Among 30-day survivors, all-cause and HF 30-day readmission rates were 18% (< 70 years, 22%; ≥ 90 years, 13%) and 5%, respectively. Reimbursements among 30-day survivors comprised at least a beta-blocker in 54% of cases, diuretics in 85%, angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in 67%, a diuretic and ACEI/ARB combination in 23% and a beta-blocker, ACEI/ARB and diuretic combination in 37%. Patients admitted for HF presented high rates of co-morbidity, readmission and death at 30 days, and there remains room for improvement in their drug treatments; these findings indicate the need for improvement in return-home and therapeutic education programmes.

Telemonitoring looking good for heart failure in France

Telemonitoring looking good for heart failure in France

107 Care management of heart failure in elderly patients in France. Results from the DEVENIR study

The part of elderly patients (pts) in heart failure (HF) population is growing. They might pose specific problems due to the greater proportion of HF with preserved LVEF, more frequent comorbidities or contra-indications to recommended HF treatment. to describe the care management of pts > 80-year treated for HF in France. Cross sectional observational survey with retrospective collection of data at hospital discharge. Pts must have been diagnosed with CHF and have been hospitalised for CHF within the previous 18 months. Pts are classified according to the LVEF at hospital discharge. 412 French outhospital cardiologists entered 1 452 pts meeting the inclusion criteria. FEVG at hospital discharge was known for 1408 pts. 355 (25%) were more than 80-year-old. Management care at hospital discharge according to age and LVEF is detailed below. LVEF < 40% LVEF 40-50% LVEF > 50% Total Age>80 ACEI/ARB 84% 81% 80% 82% * BB 71% 67% 40% † , ‡ 62% * Loop diuretics 92% 85% 85% 88% Spironolactone/eplerenone 26% 20% 18% 22% * Digoxin 20% 15% 29% 21% * Calcium antagonists 10% 14% 37% † , ‡ 18% Anticoagulants 49% 45% 51% 49% * Age ≤ 80 ACEI/ARB 93% 93% 85% † , ‡ 92% BB 79% 78% 76% 79% Loop diuretics 90% 82% 79% † , § 86% Spironolactone/eplerenone 35% 21% 25% † , § 30% Digoxin 16% 15% 16% 15% Calcium antagonists 9% 19% 21% † , § 13% Anticoagulants 42% 39% 39% 41% † p<0.05 for comparisons between LVEF > 50% and LVEF<40%; ‡ p<0.05 for comparisons between LVEF>50% and LVEF between 40% and 50%; § : p<0.05 for comparisons between LVEF<40% and LVEF between 40% and 50%; * p<0.05 for comparisons between > 80 and ≤ 80 years old adjusted for LVEF. BB, ACEI/ARB, spironolactone/eplerenone are less often prescribed in elderly patients contrasting with digoxin and anticoagulants prescription. These differences persist after adjustment on LVEF.

554 Factors limiting betablockers prescription by cardiologists in systolic heart failure in France

554 Factors limiting betablockers prescription by cardiologists in systolic heart failure in France