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1.
Ann Cardiol Angeiol (Paris) ; 72(5): 101630, 2023 Nov.
Article in French | MEDLINE | ID: mdl-37541169

ABSTRACT

INTRODUCTION: Return to home after discharge for congestive heart failure (CHF) is associated with prolonged and recurrent hospitalizations, the prognosis remains poor. Since 2013, the Caisse Nationale d'Assurance Maladie (CNAM) with the Société Française de Cardiologie (SFC) has set up a support program PRADO-IC (support program for returning home after hospitalization for heart failure). THE AIM OF THIS STUDY: was to describe the program, to present epidemiologic data, and the evaluations by the CNAM, and by clinical studies, then to expose strengths limits and perspectives. RESULTS: After the inclusion a CPAM advisor organize the outcome, the care of the outpatient is based on his general practitioner (GP) and a private nurse trained in CHF care during a three-months program. Between 2017 and 2019, 20 264 patients per year were hospitalized in Ile de France, 8.8% were included in PRADO-IC. The retrospective CNAM evaluations were positive: follow up criteria were improved and mortality rate at 6 months was lower (10.3% vs. 14.1%). However, clinical retrospective study of Troyes hospital (n = 89), and Paris Saint Joseph Hospital (n = 633), did not confirm these results: rate mortality and/or re-hospitalization were not different between patients and control. Several prospective studies are underway; results will be soon available. Limits of PRADO-IC are discussed like the lack of inclusion criteria, lack of geriatric evaluation, or the pivotal role based on GP, and the short term of duration. Strengths are its existence, national reach, multi-disciplinary approach, educational contents. Clinical studies showed that the PRADO-IC program concerned to the most severe patients. Despite this, the one-year mortality and the HF readmission rate are the same than out-program patients. CONCLUSION: PRADO-IC is the one and the only national transition of care program for IC patients. First evaluations are positive but prospective evaluation studies are needed in order to limit methodologic bias.

2.
Ann Cardiol Angeiol (Paris) ; 71(5): 267-275, 2022 Nov.
Article in French | MEDLINE | ID: mdl-35940973

ABSTRACT

INTRODUCTION: Congestive heart failure (CHF) is associated with prolonged and recurrent hospitalizations; the prognosis remains poor. Since 2013, the Caisse Primaire d'Assurance Maladie (CPAM) has set up a support program PRADO-IC (support program for returning home after hospitalisation for heart failure). The aim of this study was to evaluate the impact of PRADO-IC on the heart failure readmission rate and death rate at one year. METHODS: From September 2016 to September 2018, all patients hospitalized for heart failure at Saint-Joseph Hospital were included in an observational study. The inclusion in PRADO-IC program was at physician's discretion. Two groups were compared according to the inclusion in PRADO-IC or not (T). The primary endpoints were the comparison of one-year mortality and heart failure readmission rate between the two groups. RESULTS: Six hundred and thirty-three patients were included, 262 in the PRADO-IC group and 371 in the non-PRADO group. Patients in the PRADO-IC cohort more frequently present severity criteria (age, weight, BNP level, arrhythmia, anemia, renal failure). Mortality at one year (19.5% vs 16.2%, p = 0.28) are equivalent in both groups. There were no significant differences in one-year rehospitalization rate for heart failure (HF) (35.1% in PRADO cohort vs 28% in T group, p = 0.06), the time to first hospitalization (74.5 days in PRADO vs 54.5 days in T, p = 0.55) and the length of hospitalization (6.0 days in PRADO vs 7.0 days in T, p = 0.29) between the two groups. Age, hyponatremia, anemia, cancer, HF re-hospitalization were variables linked to a risk of mortality, in a multivariable analysis. CONCLUSION: Our study shows that the PRADO-IC program concerned to the most severe patients. Despite this, the one-year mortality and the HF readmission rate are similar between the two groups.


Subject(s)
Heart Failure , Patient Readmission , Humans , Hospitalization , Heart Failure/epidemiology , Prognosis , Heart Rate
3.
Ann Cardiol Angeiol (Paris) ; 70(5): 294-298, 2021 Nov.
Article in French | MEDLINE | ID: mdl-34517970

ABSTRACT

INTRODUCTION: Congestiveheart failure (CHF) is associated with prolonged and recurrent hospitalizations, the prognosis remains poor. The aim of this study was to collect epidemiologic data at admission and at six month follow-up in a cohort of patients with CHF admitted to a single center between 2017 and 2019 (Saint Joseph Hospital, HSJ) and to compare these data with regional data (Ile-de-France, IdF). METHODS: Local and regional data were provided by National Health Service, Regional Department of Ile de France(DRSM) using national data base. CHF in-hospital stay was defined by appropriate CIM 10 code reported on the final medical form. RESULTS: From 2017 to 2019, 1967 CHF in-hospital stays were collected, mean age of the population was 81.4 (=mean) ± 11.7 yearsIC95% [80.8; 81.9], mean length of stay was 8.6 ± 6.8 days IC95% [8.3; 8.9], in-hospital mortality was 5.3 %, 9.6% at 2nd month and 15.9% at 6th month. Readmission rate was 23.7%, time to readmission was 59.5 ± 47.5 days IC95% [57.4; 61.6]. IdF data collected 60973 CHF in-hospital stays at the same period. Compared to the IdF population, our population was older (81.4 ± 11.6 versus 80.4 ± 12.6 years, p = 0.001). Length of stay was shorter (8.6 ± 6.8 versus 11.3 ± 10.1 days p<0.001), in-hospital mortality was lower (5.3% versus 7.8% p < 0.001), 2nd month and 6th month mortality was lower (respectively 9.6% versus 14.2% and 15.9% versus 21.3%, p <0.001), home discharge rate was higher (66.9% versus 60.8%, p < 0.001) in the HSJ population. The proportion of patients included in PRADO-IC program (Programme d'aide au retour à domicile-Insuffisance Cardiaque, Returning home support program) was higher in SJ population (22.6% versus 8.8% p < 0.001). CONCLUSION: CHF admission involved elderly patients, the in-hospital and 6th month mortality is high, with early and frequent readmissions. Differences between HSJ and IdF populations may be explained by the heterogeneity of health care facilities, management facilities and organization of transition of care.


Subject(s)
Heart Failure , State Medicine , Aged , Heart Failure/epidemiology , Heart Failure/therapy , Hospitalization , Humans , Length of Stay , Patient Discharge , Patient Readmission
4.
Diabetes Obes Metab ; 23(2): 434-443, 2021 02.
Article in English | MEDLINE | ID: mdl-33118250

ABSTRACT

AIMS: To assess the prevalence, type and clinical factors associated with left ventricular (LV) dysfunction in patients with type 2 diabetes mellitus (T2DM) by performing a comprehensive echocardiographic Doppler assessment including speckle tracking. METHODS: Two hundred T2DM patients without overt cardiovascular disease were prospectively enrolled in a single-centre cohort study between 2018 and 2019. RESULTS: Left ventricular mass was increased in 24 patients (12%) and relative wall thickness (h/r) was increased in 46 patients (23%). Left atrial (LA) enlargement was observed in 27 patients (13.6%) and global longitudinal strain (GLS) was reduced in 38 patients (20.3%). In univariate analysis, LV hypertrophy (LVH) or increased h/r were associated with age, renal function, hypertension and B-type natriuretic peptide (BNP) plasma level. LA dilation was associated with age, history of hypertension, diabetes duration and complications, insulin treatment, BNP level and renal function. GLS was associated with body mass index (BMI) and, in a borderline manner, with diabetes duration. In multivariate analysis, hypertension was associated with LVH and with h/r and a borderline relationship was observed for female gender (LVH), age and insulin treatment (h/r). Age, hypertension and, in a borderline manner, insulin treatment were associated with LA dilation. BMI and shorter diabetes duration were associated with reduced GLS. CONCLUSION: A high prevalence of asymptomatic cardiac dysfunction/structural abnormalities was observed in patients with T2DM without overt cardiac disease and was associated with either age, diabetes duration or treatment and with comorbidities including hypertension and obesity. Whether these preclinical abnormalities are associated with poor outcomes warrants further study.


Subject(s)
Cardiovascular Diseases , Diabetes Mellitus, Type 2 , Ventricular Dysfunction, Left , Cohort Studies , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/epidemiology , Female , Humans , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Left/epidemiology , Ventricular Dysfunction, Left/etiology , Ventricular Function, Left
5.
J Am Soc Echocardiogr ; 21(9): 1079, 2008 Sep.
Article in English | MEDLINE | ID: mdl-18187303

ABSTRACT

To date, few cases giving detailed visual descriptions of a thrombus in the pulmonary arteries or its branches in transthoracic echocardiography have been reported. We report the case of a 67-year-old man who was admitted to a hospital emergency department with a thrombus in the right pulmonary artery diagnosed by transthoracic echocardiography. The specificity of echocardiography in pulmonary embolism varies between 80% and 90% according to the series. The direct visualization of a thrombus is sometimes possible, permitting a faster diagnosis in patients with compromised hemodynamic status.


Subject(s)
Echocardiography/methods , Image Enhancement/methods , Pulmonary Artery/diagnostic imaging , Pulmonary Embolism/diagnostic imaging , Aged , Humans , Male
6.
J Clin Microbiol ; 40(7): 2689-90, 2002 Jul.
Article in English | MEDLINE | ID: mdl-12089310

ABSTRACT

Enterococcus hirae is a rare isolate in clinical specimens. We describe a case of native aortic-valve endocarditis that was caused by Enterococcus hirae in a 72-year-old man. This is the first reported case of endocarditis due to this organism.


Subject(s)
Endocarditis, Bacterial/microbiology , Enterococcus/pathogenicity , Gram-Positive Bacterial Infections/microbiology , Heart Valve Diseases/microbiology , Aged , Aortic Valve/microbiology , Enterococcus/classification , Enterococcus/isolation & purification , Humans , Male , Microscopy, Electron
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