Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 13 de 13
Filter
1.
Ann Cardiol Angeiol (Paris) ; 70(5): 326-331, 2021 Nov.
Article in French | MEDLINE | ID: mdl-34629173

ABSTRACT

Implantable cardiac monitors are recommended and reimbursed in two specific cases: the etiological diagnosis of unexplained recurrent syncope and the etiological diagnosis of a cryptogenic ischemic stroke. According to the French National Authority for Health (HAS), remote monitoring "leads to early diagnosis and therapeutic care". However, remote tracking of these devices for diagnostic purposes is not included in the ETAPES program, which will end soon. This article presents a summary of the evaluation by HAS of the remote monitoring of implantable cardiac monitors. It also addresses the question of its reimbursement, as for therapeutic implantable devices.


Subject(s)
Electrocardiography , Syncope , Arrhythmias, Cardiac , Humans , Recurrence
2.
Ann Cardiol Angeiol (Paris) ; 70(5): 348-350, 2021 Nov.
Article in French | MEDLINE | ID: mdl-34629174

ABSTRACT

Telemedicine is considered as an appropriate solution to a large number of challenges in the health care field. The legal recognition of telemedicine by the French "Hospital, Patient, Health, Territory" law of July 21th, 2009 marks the implementation of a public strategy for the deployment of the activity in France and gives it an official definition. As a tool for producing remote care, telehealth offers an optimal response to the medical desert issues. In that way, in a context of cost effectiveness, telehealth provides a new model of healthcare organization within the health territories. Thus, telemedicine leads to interprofessional cooperation, as authorized and regulated by the hospital-health-territory law. However, it requires effective coordination implying professional qualification for the coordinator's job.


Subject(s)
Cardiology , Telemedicine , Critical Pathways , France , Hospitals , Humans
4.
Ann Cardiol Angeiol (Paris) ; 70(5): 312-316, 2021 Nov.
Article in French | MEDLINE | ID: mdl-34548128

ABSTRACT

This survey evaluated hypnosis practice in French centres in June 2020. The survey was sent via email to different rhythmology centres in France and responses from cardiologists and nurses were obtained. We present here the preliminary results of this survey. Hypnosis was used on a regular basis in 7.5% of the centres and 13% of the participants received education on hypnosis. 75% of the participants were interested to have an education of hypnosis. The survey points the different possibilities of improvement of management of patients while having the different procedures.


Subject(s)
Hypnosis , France/epidemiology , Humans , Surveys and Questionnaires
5.
Eur Heart J Acute Cardiovasc Care ; 9(7): 788-801, 2020 Oct.
Article in English | MEDLINE | ID: mdl-30990337

ABSTRACT

In patients admitted for acute myocardial infarction, the communication and transition from specialists to primary care physicians is often delayed, and the information imparted to subsequent healthcare providers (HCPs) may be sub-optimal. A French group of cardiologists, lipidologists and diabetologists decided to establish a consensus to optimize the discharge letter after hospitalization for acute myocardial infarction. The aim is to improve both the timeframe and the quality of the content transmitted to subsequent HCPs, including information regarding baseline assessment, procedures during hospitalization, residual risk, discharge treatments, therapeutic targets and follow-up recommendations in compliance with European Society of Cardiology guidelines. A consensus was obtained regarding a template discharge letter, to be released within two days after patient's discharge, and containing the description of the patient's history, risk factors, acute management, risk assessment, discharge treatments and follow-up pathway. Specifically for post acute MI patients, tailored details are necessary regarding the antithrombotic regimen, lipid-lowering and anti-diabetic treatments, including therapeutic targets. Lastly, the follow-up pathway needs to be precisely mentioned in the discharge letter. Additional information such as technical descriptions, imaging, and quality indicators may be provided separately. A template for a standardized discharge letter based on 8 major headings could be useful for implementation in routine practice and help to improve the quality and timing of information transmission between HCPs after acute MI.


Subject(s)
Communication , Consensus , Myocardial Infarction/therapy , Patient Discharge/standards , Humans
8.
Blood Rev ; 32(4): 272-279, 2018 07.
Article in English | MEDLINE | ID: mdl-29402471

ABSTRACT

Direct oral anticoagulants (DOACs) are indicated in the treatment and prevention of venous thromboembolism (VTE). However, the use of DOACs in unusual VTE, including cerebral venous thrombosis (CVT) and splanchnic venous thrombosis (SVT), and in patients with biological thrombophilia including minor thrombophilia (Factor V Leiden and prothrombin G20210A), major innate thrombophilia (protein C and S deficiency, and antithrombin) and major acquired thrombophilia (antiphospholipid syndrome [APS]), remains controversial due to the paucity of available data. There are some reports of DOACs use in the initial treatment or long-term maintenance of patients with either CVT or SVT, but their efficacy remains unclear. The efficacy of DOACs may be suitable in patients with biological minor or major thrombophilia. The use of DOACs for the long-term maintenance of patients with APS is more contentious. Randomized clinical trials, which are currently underway, should offer definitive insight into the efficacy and safety profiles of DOACs in these patient populations.


Subject(s)
Anticoagulants/administration & dosage , Antiphospholipid Syndrome/blood , Antiphospholipid Syndrome/drug therapy , Thrombophilia/blood , Thrombophilia/drug therapy , Venous Thrombosis/blood , Venous Thrombosis/drug therapy , Administration, Oral , Antiphospholipid Syndrome/diagnosis , Antiphospholipid Syndrome/prevention & control , Clinical Trials as Topic , Humans , Thrombophilia/diagnosis , Thrombophilia/prevention & control , Treatment Outcome , Venous Thrombosis/diagnosis , Venous Thrombosis/prevention & control
9.
Arch Cardiovasc Dis ; 111(2): 85-94, 2018 Feb.
Article in English | MEDLINE | ID: mdl-28988597

ABSTRACT

Non-vitamin K antagonist oral anticoagulants (NOACs) - dabigatran, rivaroxaban, apixaban and edoxaban - are well established in terms of preventing stroke or systemic embolism in patients with non-valvular atrial fibrillation and high thromboembolism risk. When prescribed incorrectly, NOACs are associated with an increased risk of ischaemic events and bleeding. Current NOAC labels explicitly address dose adjustments according to age, body weight, renal function and concomitant treatment with P-glycoprotein inhibitors. The required dose adjustments vary significantly from molecule to molecule, thereby creating a complex dose adjustment environment. Furthermore, recommendations support assessment of individual risk using thromboembolic and bleeding risk scores. Evidence-based medicine also provides data about specific patient profiles. In particular, some patients who are at higher risk of bleeding, such as patients on polymedication, are often at higher risk of stroke. More and more patients are being treated with NOACs. The question of appropriate dosing has become important, as studies are starting to show that reduced doses are being prescribed at very high rates. Although these data have not been evaluated in light of individual risk assessments, in everyday practice, physicians are often more concerned about drug-related bleeding than about the spontaneous evolution of the disease (stroke/systemic embolism), leading to high rates of prescription of inadequately low doses. Recent results have shown that only certain risk criteria justify dose reduction. Thus, the right dose needs to be prescribed for the right patient in order to obtain, in real-life practice, the benefits of NOACs that have been demonstrated in randomized clinical trials.


Subject(s)
Anticoagulants/administration & dosage , Atrial Fibrillation/drug therapy , Blood Coagulation/drug effects , Stroke/prevention & control , Administration, Oral , Aged , Aged, 80 and over , Anticoagulants/adverse effects , Anticoagulants/pharmacokinetics , Atrial Fibrillation/blood , Atrial Fibrillation/complications , Atrial Fibrillation/diagnosis , Clinical Decision-Making , Dose-Response Relationship, Drug , Drug Dosage Calculations , Female , Hemorrhage/chemically induced , Humans , Male , Middle Aged , Patient Selection , Risk Factors , Stroke/blood , Stroke/diagnosis , Stroke/etiology , Treatment Outcome
10.
Pacing Clin Electrophysiol ; 40(5): 527-536, 2017 May.
Article in English | MEDLINE | ID: mdl-28244117

ABSTRACT

BACKGROUND: Remote monitoring (RM) can remotely detect atrial tachyarrhythmias (ATAs). The benefit of RM compared to conventional follow-up in the detection and management of ATA was assessed in recipients of dual-chamber pacemakers. METHODS: The multicenter randomized SETAM study enrolled 595 patients in sinus rhythm with a CHA2 DS2 -VASc score ≥2, without ATA history and untreated with antiarrhythmics and antithrombotics, randomly assigned to RM (RM-ON; n = 291) versus ambulatory follow-up (RM-OFF; n = 304) during 12.8 ± 3.3 months. ATA occurrence, burden, and management were analyzed together with adverse clinical events. RESULTS: Patients were 79 ± 8 years old, 63% men, with a CHA2 DS2 -VASc score of 3.7± 1.2. ATA were detected in 83 patients (28%) in the RM-ON versus 66 (22%) in the RM-OFF group (P = 0.06). The median time between the pacemaker implantation and the first treated ATA was 114 days [44; 241] in the RM-ON versus 224 days [67; 366] in the RM-OFF group (hazard ratio [HR] = 0.56; 95% confidence interval [CI]: 0.37-0.86; P = 0.01). Therapies for ATA were initiated in 92 patients and the time to treatment of ATA was shortened by 44% in the RM-ON group (HR = 0.565; 95% CI: 0.37-0.86; P = 0.01). Over the last 4 months of follow-up, the mean ATA burden was alleviated by 4 hours/day (18%) in the RM-ON group. The rate of adverse clinical events was similar in both groups. CONCLUSION: Remotely monitored patients were diagnosed and treated earlier for ATA, and subsequently had a lower ATA burden.


Subject(s)
Atrial Fibrillation/mortality , Atrial Fibrillation/prevention & control , Cardiac Pacing, Artificial/mortality , Electrocardiography, Ambulatory/statistics & numerical data , Tachycardia, Ectopic Atrial/mortality , Tachycardia, Ectopic Atrial/prevention & control , Telemedicine/statistics & numerical data , Aged , Atrial Fibrillation/diagnosis , Cardiac Pacing, Artificial/statistics & numerical data , Cost of Illness , Early Diagnosis , Female , France/epidemiology , Home Care Services/statistics & numerical data , Hospitalization/statistics & numerical data , Humans , Male , Prevalence , Risk Factors , Survival Rate , Tachycardia, Ectopic Atrial/diagnosis , Time-to-Treatment/statistics & numerical data , Treatment Outcome
11.
Europace ; 18(3): 463-7, 2016 Mar.
Article in English | MEDLINE | ID: mdl-26899998

ABSTRACT

The purpose of this patient survey was to analyse the knowledge about blood thinning medications relative to gender, age, education, and region of residence in patients with atrial fibrillation (AF). A total of 1147 patients with AF [mean age 66 ± 13 years, 529 (45%) women] from eight European countries responded to this survey. Most patients understood that the indication for anticoagulation therapy was to 'thin the blood', but 8.1% responded that the purpose of the medication was to treat the arrhythmia. Patients with college or university grades reported less frequent deviations from their target INR range compared with those without schooling (2.8% vs. 5.1%, P < 0.05). The awareness of anticoagulation-related risk of bleedings was lowest in patients without schooling (38.5%) and highest in those with college and university education (57.0%), P < 0.05. The same pattern was also observed regarding patient's awareness of non-vitamin K antagonist oral anticoagulants (NOACs): 56.5% of the patients with university education and only 20.5% of those without schooling (P < 0.05) knew about NOACs, indicating that information about new anticoagulation therapies remains well below the target. Bleeding events were statistically less frequent in patients on NOACs compared with vitamin K antagonists. The education level and patients' knowledge have a direct influence on the global management of the anticoagulation.


Subject(s)
Anticoagulants/administration & dosage , Atrial Fibrillation/drug therapy , Health Knowledge, Attitudes, Practice , Patient Education as Topic , Patients/psychology , Stroke/prevention & control , Administration, Oral , Aged , Anticoagulants/adverse effects , Atrial Fibrillation/blood , Atrial Fibrillation/complications , Blood Coagulation/drug effects , Drug Monitoring/methods , Educational Status , Europe , Female , Health Care Surveys , Hemorrhage/chemically induced , Humans , International Normalized Ratio , Male , Medication Adherence , Middle Aged , Predictive Value of Tests , Risk Assessment , Risk Factors , Stroke/etiology , Treatment Outcome , Vitamin K/antagonists & inhibitors
12.
Europace ; 14(10): 1465-74, 2012 Oct.
Article in English | MEDLINE | ID: mdl-22547767

ABSTRACT

AIMS: Inappropriate therapy delivered by implantable cardioverter defibrillators (ICDs) remains a challenge. The OPERA registry measured the times to, and studied the determinants of, first appropriate (FAT) and inappropriate (FIT) therapies delivered by single-, dual- and triple-chamber [cardiac resynchronization therapy defibrillator (CRT-D)] ICD. METHODS AND RESULTS: We entered 636 patients (mean age = 62.0 ± 13.5 years; 88% men) in the registry, of whom 251 received single-, 238 dual-, and 147 triple-chamber ICD, for primary (30.5%) or secondary (69.5%) indications. We measured times to FAT and FIT as a function of multiple clinical characteristics, examined the effects of various algorithm components on the likelihood of FAT and FIT delivery, and searched for predictors of FAT and FIT. Over 22.8 ± 8.8 months of observation, 184 patients (28.9%) received FAT and 70 (11.0%) received FIT. Ventricular tachycardia (VT) was the trigger of 88% of FAT, and supraventricular tachycardia was the trigger of 91% of FIT. The median times to FIT (90 days; range 49-258) and FAT (171 days; 50-363) were similar. The rate of FAT was higher (P <0.001) in patients treated for secondary than primary indications, while that of FIT were similar in both groups. Out of 57 analysable FIT, 27 (47.4%) could have been prevented by fine tuning the device programming like the sustained rate duration or the VT discrimination algorithm. CONCLUSIONS: First inappropriate therapy occurred in 11% of 636 ICD recipients followed for ∼2 years. Nearly 50% of FIT could have been prevented by improving device programming.


Subject(s)
Defibrillators, Implantable/adverse effects , Prosthesis Failure/adverse effects , Tachycardia, Supraventricular/therapy , Tachycardia, Ventricular/therapy , Aged , Algorithms , Cardiac Resynchronization Therapy/methods , Defibrillators, Implantable/statistics & numerical data , Female , France , Humans , Incidence , Male , Middle Aged , Registries , Treatment Outcome
13.
Eur J Echocardiogr ; 10(4): 556-61, 2009 Jun.
Article in English | MEDLINE | ID: mdl-19202147

ABSTRACT

AIMS: The aim of this article was to assess whether abnormal dobutamine stress echocardiography (DSE) can be due to a dobutamine-induced coronary spasm in patients with angiographically documented vasospastic coronary arteries. METHODS AND RESULTS: Between January 2004 and April 2008, we prospectively evaluated all patients with known or suspected coronary artery disease (CAD) referred to the echocardiography laboratory for dobutamine stress tests (6061 examinations). Those with abnormal DSE underwent coronary angiogram with a systematic methylergometrine intracoronary injection in the case of absence of significant coronary stenosis or spontaneous occlusive coronary spasm. Patients who had spontaneous occlusive coronary spasm or positive methylergometrine test, but no significant stenoses, were ultimately included in this study. About 581 patients had abnormal DSE, among them only 20 (3.4%) fulfilled the inclusion criteria. There were 15 males and 5 females, and mean age was 64.35 years (range 52-85); 8 patients had a known history of CAD and all of them had at least two established cardiovascular risk factors. The culprit vessel was the left anterior descending artery in 10 cases (50%), right coronary artery in 8 cases (40%), and left circumflex in 2 cases (10%). There was a systematic correspondence between the culprit arteries and dobutamine-induced wall motion abnormality territories. No complications occurred during examination or during the provocation test. All the patients were discharged with a calcium channel blocker and were doing well after 13 months of mean follow-up. CONCLUSION: Coronary artery spasm can be induced at DSE, but is a rare finding; it could, though, be clinically relevant as it may partly explain some erroneously labelled 'false-positive' examinations. Methylergometrine provocation test is a safe and advisable approach in such situations.


Subject(s)
Coronary Artery Disease/diagnostic imaging , Coronary Vasospasm/etiology , Echocardiography, Stress/adverse effects , Adrenergic beta-Agonists/administration & dosage , Aged , Aged, 80 and over , Coronary Angiography , Coronary Artery Disease/complications , Coronary Stenosis/diagnostic imaging , Coronary Vasospasm/diagnostic imaging , Dobutamine/administration & dosage , Echocardiography , Electrocardiography , False Positive Reactions , Female , Humans , Male , Methylergonovine , Middle Aged , Oxytocics , Prospective Studies
SELECTION OF CITATIONS
SEARCH DETAIL
...