Société Française de Cardiologie
Type de publication
Revue ACVD
SFC - ACVd Article du mois - Juillet 2020

ACVD - Article du mois [Juillet 2020]

Sarah F Feldman, Thomas Lesuffleur, Valérie Olié, Christelle Gastaldi-Ménager, Yves Juillière, Philippe Tuppin

Contenu de la publication


Background. - Guidelines have been published concerning patient management after hospi-talization for heart failure. The French national healthcare database (Système national desdonnées de santé; SNDS) can be used to compare these guidelines with real-life practice.

Aims. - To study healthcare utilization 30 days before and after hospitalization for heart failure,and the variations induced by the exclusion of institutionalized patients, who are less exposedto outpatient healthcare utilization.

Methods. - We identified the first hospitalization for heart failure in 2015 of adult beneficiariesof the health insurance schemes covering 88% of the French population, who were alive 30 daysafter hospitalization. Outpatient healthcare utilization rates during the 30 days after hospital-ization and the median times to outpatient care, together with their interquartile ranges, weredescribed for all patients, and for a subgroup excluding institutionalized patients.

Results. - Among the 104,984 patients included (mean age 79 years; 52% women), 74% werenon-institutionalized (mean age 78 years; 47% women). The frequencies of at least one consul-tation after hospitalization and the median times to consultation were 69% (total sample) vs.78% (subgroup excluding institutionalized patients) and 8 days (interquartile range 3; 16) vs. 7days (3; 15) for general practitioners, 20% vs. 21% and 14 days (7; 23) vs. 16 days (9; 24) forcardiologists and 58% vs. 69% and 3 days (1; 9) vs. 2 days (1; 7) for nurses, with reimbursementof diuretics in 77% vs. 86%, angiotensin-converting enzyme inhibitors or angiotensin II receptorblockers in 48% vs. 55% and beta-blockers in 55% vs. 63%. Departmental variations, excludinginstitutionalized patients, were large: general practice consultations (interquartile range 74%;83%), cardiology consultations (11%; 23%) and nursing care (68%; 77%).

Conclusions. - Low outpatient healthcare utilization rates, long intervals to first healthcareutilization and departmental variations indicate a mismatch between guidelines and real-lifepractice, which is accentuated when including institutionalized patients.

Keywords. - Guidelines; Heart failure; Hospitalization; Observational study; Outpatient care

Abbreviations. - ACE/Angiotensin-converting enzyme; ALD/Affection de longue durée (long-term disease); ARB/Angiotensin II receptor blocker; HF/Heart failure; ICD-10/International Classification of Diseases, 10th revision; ICU/Intensive care unit; IQR/Interquartile range; SNDS/Système national des données de santé (national healthcare database)

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