Patient care pathways in acute heart failure and their impact on in-hospital mortality, a French national prospective survey

Gorlicki, Judith; Boubaya, Marouane; Cottin, Yves; Angoulvant, Denis; Soulat, Louis; Guinemer, Sabine; Bloch-Queyrat, Coralie; Deltour, Sandrine; Lambert, Yves; Juillière, Yves; Adnet, Frédéric

doi:10.1016/j.ijcha.2019.100448

Cited by 12 publications

(15 citation statements)

References 25 publications

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“…When comparing the baseline characteristics, our cohort showed a remarkably high prevalence of comorbidities such as diabetes mellitus and chronic kidney disease, which explains the relatively high event rate 38,40 . In line with our findings, higher age and NYHA class were found as predictors of fatal outcome 24,39 . Akintoye and colleagues also reported a significant association of CCI with in‐hospital mortality, but there has been no distinction between elective and non‐elective hospital admission in their study 41 .…”

Section: Discussionsupporting

confidence: 81%

“…Data analysis showed an increased case severity according to the number of comorbidities as well as clinical presentation with a higher proportion of cases with NYHA class IV. As NYHA class was found to be a significant predictor of in‐hospital mortality previously and within our cohort, this might partly explain the higher in‐hospital death rate 24 . Several predictors for fatal outcome have been described.…”

Section: Discussionsupporting

confidence: 61%

“…In‐hospital mortality rates in previously published studies investigating non‐electively hospitalized HF populations range from 4.0–8.0% with a decrease during the last years 24,36–40 . When comparing the baseline characteristics, our cohort showed a remarkably high prevalence of comorbidities such as diabetes mellitus and chronic kidney disease, which explains the relatively high event rate 38,40 .…”

Section: Discussionmentioning

confidence: 66%

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In‐hospital care in acute heart failure during the COVID‐19 pandemic: insights from the German‐wide Helios hospital network

König

Hohenstein

Meier‐Hellmann

et al. 2020

European J of Heart Fail

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Aims The coronavirus disease 2019 (COVID‐19) pandemic has led to changes in health care utilization for different acute cardiovascular diseases. Whether hospitalization rates and in‐hospital mortality were affected by the pandemic in patients with acute symptomatic heart failure (HF) was investigated in this study. Methods and results Administrative data provided by 67 German Helios hospitals were examined for patients with a main discharge diagnosis of HF using ICD codes. Urgent hospital admissions per day were compared for a study period (13 March–21 May 2020) with control intervals in 2020 (1 January–12 March) and 2019 (13 March–21 May), resulting in a total of 13 484 patients excluding all patients with laboratory‐proven COVID‐19 infection. Incidence rate ratios (IRR) were calculated using Poisson regression. Generalized linear mixed models were used for univariable and multivariable analysis to identify predictors of in‐hospital mortality. The number of admissions per day was lower in the study period compared to the same year [IRR 0.69, 95% confidence interval (CI) 0.67–0.73, P < 0.01] and the previous year control group (IRR 0.73, 95% CI 0.70–0.76, P < 0.01). Age was similar throughout the intervals, but case severity increased in terms of distribution within New York Heart Association (NYHA) classes and comorbidities. Within the study period, 30‐day rates for urgent hospital readmissions were higher compared to the same year but not the previous year control group. In‐hospital mortality was 7.3% in the study period, 6.1% in the same year (P = 0.03) and 6.0% in the previous year control group (P = 0.02). In multivariable analysis, age, NYHA class and other predictors of fatal outcome were identified but hospitalization during the study period was not independently associated with mortality. Conclusion Our data showed a significant reduction of urgent hospital admissions for HF with increased case severity and concomitant in‐hospital mortality during the COVID‐19 pandemic in Germany. Identifying causes of reduced inpatient treatment rates is essential for the understanding and valuation with regard to future optimal management of patients with HF.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 66%

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In‐hospital care in acute heart failure during the COVID‐19 pandemic: insights from the German‐wide Helios hospital network

König

Hohenstein

Meier‐Hellmann

et al. 2020

European J of Heart Fail

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“…Access to specialized care has a strong impact on patient prognosis, including a shorter hospital stay and a lower risk of hospital death, with no specific difference, however, in outcome after hospital discharge 7,17,18 . The heterogeneity of care pathway observed in this study and in that of Smeets et al suggested the need for multiple solutions, specific to each situation 19 .…”

Section: Discussionmentioning

confidence: 54%

“…A recently published study by Gorliki et al reported that a hospital course of care involving a cardiology department was associated with an increase in hospital survival in AHF patients. These finding may highlight the importance of collaboration between cardiologists and other in‐hospitals specialties, such as emergency physicians, in order to find the best in‐hospital pathway for patients with AHF 7 …”

Section: Discussionmentioning

confidence: 88%

First symptoms and health care pathways in hospitalized patients with acute heart failure: ICPS2 survey. A report from the Heart Failure Working Group (GICC) of the French Society of Cardiology

Beauvais

Tartière

Pezel

et al. 2021

Clinical Cardiology

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Background Acute heart failure (AHF) is a common serious condition that contributes to about 5% of all emergency hospital admissions in Europe. Hypothesis To assess the type and chronology of the first AHF symptoms before hospitalization and to examine the French healthcare system pathways before, during and after hospitalization. Material and Methods A retrospective observational study including patients hospitalized for AHF Results 793 patients were included, 59.0% were men, 45.6% identified heart failure (HF) as the main cause of hospitalization; 36.0% were unaware of their HF. Mean age was 72.9 ± 14.5 years. The symptoms occurring the most before hospitalization were dyspnea (64.7%) and lower limb edema (27.7%). Prior to hospitalization, 47% had already experienced symptoms for 15 days; 32% of them for 2 months. Referral to hospital was made by the emergency medical assistance service (SAMU, 41.6%), a general practitioner (GP, 22.3%), a cardiologist (19.5%), or the patient (16.6%). The modality of referral depended more on symptom acuteness than on type of symptoms. A sudden onset of AHF symptoms led to making an emergency call or to spontaneously attending an emergency room (ER), whereas cardiologists were consulted when symptoms had already been present for over 15 days. Cardiologists referred more patients to cardiology departments and fewer patients to the ER than general practitioners or the SAMU. Conclusion This study described the French healthcare system pathways before, during and after hospitalization AHF. AHF clinic network should be developed to provide adequate care for all HF patients and create awareness regarding AHF symptoms.

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Effect of an Emergency Department Care Bundle on 30-Day Hospital Discharge and Survival Among Elderly Patients With Acute Heart Failure

Freund

Cachanado

Delannoy

et al. 2020

JAMA

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IMPORTANCE Clinical guidelines for the early management of acute heart failure in the emergency department (ED) setting are based on only moderate levels of evidence, with subsequent low adherence to these guidelines.OBJECTIVE To test the effect of an early guideline-recommended care bundle on short-term prognosis in older patients with acute heart failure in the ED. DESIGN, SETTING, AND PARTICIPANTSStepped-wedge cluster randomized trial in 15 EDs in France of 503 patients 75 years and older with a diagnosis of acute heart failure in the ED from December 2018 to September 2019 and followed up for 30 days until October 2019.INTERVENTIONS A care bundle that included early intravenous nitrate boluses; management of precipitating factors, such as acute coronary syndrome, infection, or atrial fibrillation; and moderate dose of intravenous diuretics (n = 200). In the control group, patient care was left to the discretion of the treating emergency physician (n = 303). Each center was randomized to the order in which they switched to the "intervention period." After the initial 4-week control period for all centers, 1 center entered in the intervention period every 2 weeks. MAIN OUTCOMES AND MEASURESThe primary end point was the number of days alive and out of hospital at 30 days. Secondary outcomes included 30-day all-cause mortality, 30-day cardiovascular mortality, unscheduled readmission, length of hospital stay, and kidney impairment.RESULTS Among 503 patients who were randomized (median age, 87 years; 298 [59%] women), 502 were analyzed. In the intervention group, patients received a median (interquartile range) of 27.0 (9-54) mg of intravenous nitrates in the first 4 hours vs 4.0 (2.0-6.0) mg in the control group (adjusted difference, 23.8 [95% CI, 13.5-34.1]). There was a significantly higher percentage of patients in the intervention group treated for their precipitating factors than in the control group (58.8% vs 31.9%; adjusted difference, 31.1% [95% CI, 14.3%-47.9%]). There was no statistically significant difference in the primary end point of the number of days alive and out of hospital at 30 days (median [interquartile range], 19 [0-24] d in both groups; adjusted difference, −1.9 [95% CI, −6.6 to 2.8]; adjusted ratio, 0.88 [95% CI, 0.64-1.21]). At 30 days, there was no significant difference between the intervention and control groups in mortality (8.0% vs 9.7%; adjusted difference, 4.1% [95% CI, −17.2% to 25.3%]), cardiovascular mortality (5.0% vs 7.4%; adjusted difference, 2.1% [95% CI, −15.5% to 19.8%]), unscheduled readmission (14.3% vs 15.7%; adjusted difference, −1.3% [95% CI, −26.3% to 23.7%]), median length of hospital stay (8 d in both groups; adjusted difference, 2.5 [95% CI, −0.9 to 5.8]), and kidney impairment (1% in both groups).CONCLUSIONS AND RELEVANCE Among older patients with acute heart failure, use of a guideline-based comprehensive care bundle in the ED compared with usual care did not result in a statistically significant difference in the number of days alive and out of the hospital a...

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Patient care pathways in acute heart failure and their impact on in-hospital mortality, a French national prospective survey

Cited by 12 publications

References 25 publications

In‐hospital care in acute heart failure during the COVID‐19 pandemic: insights from the German‐wide Helios hospital network

In‐hospital care in acute heart failure during the COVID‐19 pandemic: insights from the German‐wide Helios hospital network

First symptoms and health care pathways in hospitalized patients with acute heart failure: ICPS2 survey. A report from the Heart Failure Working Group (GICC) of the French Society of Cardiology

Effect of an Emergency Department Care Bundle on 30-Day Hospital Discharge and Survival Among Elderly Patients With Acute Heart Failure

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