ABSTRACT
BACKGROUND: To evaluate the prevalence and management of heart failure (HF) in very old patients in geriatric settings. METHODS: Members of the French Society of Geriatrics and Gerontology throughout France were invited to participate in a point prevalence survey and to include all patients ≥80 years old, hospitalized in geriatric settings, with HF (stable or decompensated) on June 18, 2012. General characteristics, presence of comorbidities, blood tests and medications were recorded. RESULTS: Among 7,197 patients in geriatric institution, prevalence of HF was 20.5% (n = 1,478): (27% in acute care, 24.2% in rehabilitation care and 18% in nursing home). Mean age was 88.2 (SD = 5.2) and Charlson co morbidity score was high (8.49 (SD = 2.21)). Left ventricular ejection fraction (LVEF) was available in 770 (52%) patients: 536 (69.6%) had a preserved LVEF (≥ 50%), 120 (15.6%) a reduced LVEF (< 40%), and 114 (14.8%) a midrange LVEF (40-49%). Prescription of recommended HF drugs was low: 42.6% (629) used Angiotensin Converting Enzyme Inhibitors (ACEI) or Angiotensin Receptor Blockers (ARBs), 48.0% (709) ß-blockers, and 21.9% (324) ACEI or ARB with ß-blockers, even in reduced LVEF. In multivariate analysis ACEI or ARBs were more often used in patients with myocardial infarction (1.36 (1.04-1.78)), stroke (1.42 (1.06-1.91)), and diabetes (1.54 (1.14-2.06)). ß blockers were more likely used in patients with myocardial infarction (2.06 (1.54-2.76)) and atrial fibrillation (1.70 (1.28-2.28)). CONCLUSION: In this large very old population, prevalence of HF was high. Recommended HF drugs were underused even in reduced LVEF. These results indicate that management of HF in geriatric settings can still be improved.
Subject(s)
Disease Management , Health Services for the Aged/trends , Heart Failure/epidemiology , Heart Failure/therapy , Surveys and Questionnaires , Adrenergic beta-Antagonists/therapeutic use , Aged, 80 and over , Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Female , France/epidemiology , Heart Failure/diagnosis , Humans , Male , Societies, Medical/trends , Stroke Volume/drug effects , Stroke Volume/physiology , Ventricular Function, Left/drug effects , Ventricular Function, Left/physiologyABSTRACT
AIM OF THE STUDY: To assess the prevalence of risk factors of prion-related disease transmission in a gastrointestinal endoscopy unit. METHODS: Clinical evaluation of the risk of transmission of prion-related diseases using the criteria defined by the French circular 138 in patients referred for digestive endoscopy without anesthesia. RESULTS: 1017 patients were included in this study. According to circular 138, 7 patients (0.68%) were at high risk of transmitting prion-related disease. According to these criteria, a high index of suspicion of prion-related disease was detected in 26 patients (2.55%). Clinical evaluation of risk was not possible for 56 patients (5.51%), due to coma or sedation (38 patients) or communication impairment (18 patients). CONCLUSIONS: Application of circular 138 led us to consider that 2.55% of patients in this study had a high risk of prion-related disease. The circular criteria cannot be assessed in patients with sedation for mechanical ventilation, coma or communication impairment.
