Good Performance in the Management of Acute Heart Failure in Cardiogeriatric Departments : The ICREX-94 Experience

Abstract

Context: A growing number of elderly patients hospitalized for Acute Heart Failure (AHF) are being managed in cardiogeriatrics departments, but their characteristics and prognosis are poorly known. This study aimed to investigate the profile and outcome (rehospitalization at 90 days) of patients hospitalized for AHF in cardiogeriatrics departments in the Val-de-Marne area in the suburbs of Paris, and to compare them to AHF patients hospitalized in cardiology departments in the same area. Methods: Observational study, ICREX-94, conducted in seven cardiology departments in France and three specific cardiogeriatrics departments in Val-de-Marne. Results: A total of 308 patients were hospitalized for AHF between October 2017 and January 2019. During the 90 days following discharge, 29.6% patients were readmitted to the hospital. Compared with patients hospitalized in cardiology departments, patients in cardiogeriatrics departments were older (p<0.001), less independent (living more often alone or in an institution) (p<0.001), more often depressed (p<0.001), had more often major neurocognitive disorder (p<0.001), had a higher Human Development Index (HDI, p<0.001), and were less often diagnosed with amyloidosis (p<0.001). There was no difference in outcome whether patients were discharged from cardiology or cardiogeriatrics departments. The most frequent precipitating factors underlying AHF decompensation between the first and second hospitalization were arrhythmia and infection.Conclusion: AHF patients discharged from cardiogeriatrics departments, compared to cardiology departments, showed clinical differences but had the same prognosis regarding AHF rehospitalization at 90 days.

Estimation of the plasma volume status of elderly patients with acute decompensated heart failure using bedside clinical, biological, and ultrasound parameters

“…Transthoracic echocardiography (TTE) remains a method of choice to assess congestion by analyzing left ventricular filling pressures and the inferior vena cava (IVC) variations 4 . However, access to TTE is limited and it is performed less than one in five patients in geriatric departments 9,10 …”

“…4 However, access to TTE is limited and it is performed less than one in five patients in geriatric departments. 9,10 IVC diameter and compliance as assessed by echocardiography is a fast and effective way to obtain the right-atrial pressure with a threshold of 21 mm and respiratory variation <50% to define hypervolemia. 11,12 The IVC can guide the clinician in administering effective decongestive treatment and achieving euvolemia.…”