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OBLIC: a nationwide French prospective cohort of heart failure ambulatory patients managed in private practice
36
Archives of Cardiovascular Diseases Supplements (2017) 9, 29-45
685 The prevalence and characteristics of pulmonary hypertension and its prognosis value in chronic systolic heart failure: about 30106 cases from the Ibn Rochd-HF registry F. Sabri*, M. Abelhad, R. Habbal CHU Ibn Rochd, Cardiologie, Casablanca, Maroc *Corresponding author: [email protected]
The authors hereby declare no conflict of interest
031
Purpose Pulmonary hypertension (PH) is a predictor of mortality and morbidity in patients with chronic heart failure (HF) but it is poorly described in our population. We sought to study, the prevalence, determinants, and prognostic significance of PH in a large representative population with HF. Methods We retrospectively studied 30106 patients with chronic heart failure on the HF Registry of the university hospital Ibn Rochd Casablanca. Systolic pulmonary artery pressure PASP was determined by echocardiography, pulmonary hypertension was defined as PAPS >35 mmHg. Results we have enrolled 1753 patients in whom we could measure the PASP, the proportion of patients with PASP >35, ≥40, ≥45, and ≥50 mmHg was: 39,8%; 35,4%; 27%; 19,5% respectively. PH was present in 698/1753 patient, with an average age of 66 years, there was 61% women and 39% men, 79% of patients had low LVEF (left ventricular ejection fraction) and only 5,15% had preserved LVEF. The ischemic etiology of HF was predominant (48%). Most patients were receiving diuretics (66, 33%), beta-blockers (58, 16%) and ACE inhibitor (86, 22%), whereas 55, 10% were on Spironolactone. The etiology of PH was mostly due to the left heart disease, while only 2 cases was due to primary HP and 4,58% patient had COPD (Chronic obstructive pulmonary disease). Patients with PH had a rate of 28% of AHFD (acute heart failure decompensation) occurrence. Conclusion PH is common in HF patients; which is associated with worse LV function and provide incremental prognostic information. Thus, the estimation of PASP should be considered in the standard assessment of ambulatory HF patients and we must study it as a therapeutic way, to improve the management and prognosis of this population. The authors hereby declare no conflict of interest
657 Precipitating factors of cardiac decompensation in an African cardiological setting in patients suffering of heart failure I. Coulibaly*, D. Bamba, E. Soya, M. Zoumenou Institut de Cardiologie d'Abidjan, Médecine, Abidjan, Côte d'ivoire *Corresponding author: [email protected] Introduction Exacerbations of heart failure appear frequently associated with precipitating factors not directly related to the evolution of cardiac disease. In Sub-Saharan Africa there is a scarcity of data about those factors during the course of heart failure. Purpose The aim of this study was to examine prospectively the precipitating factors leading to hospitalization in patients with heart failure and to analyze the link between them in our medical ward. We evaluated any patient above 18 years admitted in our division for decompensate heart failure and identified the main precipitating factors for each patient. We included 160 patients and precipitating factors were identified in 149 (93.1%). Noncompliance with prescribed medications (47.5%), Bronchitis (34, 4%), Lack of adherence to the diet regimen (23.1%), appeared to be the most frequent precipitating factors in our setting. Arrhythmias (15%), Anemia (12.5%), progression of renal failure (7, 5%), uncontrolled hypertension (7%), and fever (7%) also played an important role in heart failure decompensation. In a multivariate analysis, non-compliance with drugs was strongly linked to lack of adherence to the diet regimen (OR=2.4), to fever (OR=1.97) and to uncontrolled hypertension (OR=1.88). Moreover lack of adherence to diet regimen was strongly linked to anemia (OR=2.2). Conclusion Large proportion heart failure hospitalizations are associated with preventable precipitating factors. In our setting the prevailing ones are the lack of adherence either to the prescribed medications or to the diet reg-
© Elsevier Masson SAS. All rights reserved.
imen and appeared to be strongly related one to another. There is a need to enhance the level of compliance of the patients to the diet regimen end to the medications by reinforcing their knowledge.
OBLIC: a nationwide French prospective cohort of heart failure ambulatory patients managed in private practice F. Mouquet* (1)-(2), D. Guedj-Meynier (2), G. Godin (2), T. Beard (2), M. Raphael (2), D. Attias (2), P. Tessier (2), P. Gueranger (2), L. Brottier (2), M. Abichacra (2), A. Warembourg (2), O. Hoffman (2), JP. Huberman (2), J. Gauthier (2), A. Cohen Solal (3) (1) Ramsay Générale de Santé, Hopital Privé le Bois, Lille, France – (2) Collège National des Cardiologues Français, Paris, France – (3) APHP-Hôpital Lariboisière, Cardiologie, Paris, France *Corresponding author: [email protected] Background Although private cardiologists manage the majority of patients with heart failure (HF) in France, no contemporary epidemiological data are available regarding the characteristics of these patients and the quality of care in private practice. Purpose Gathering epidemiological data and assessing the quality of care of HF patients managed in private practice. Methods A prospective cohort of HF patients was collected between January and March 2016. Private cardiologists gathered all ambulatory patients with a HF history during 2 consecutive weeks. Results A total of 1018 patients were included: 76% were managed for chronic HF with reduced ejection fraction (HFrEF) whereas 24% had history of HF with preserved ejection fraction (HFpEF). 77% had planned visits, 8% came for urgent unscheduled visits and 14% were seen after their hospitalization for decompensated HF. Mean age was 74 years (15-96). 63% among the patients were male. 61% had hypertension, 28% diabetes, 17% COPD, 14% sleep apnea, 12% chronic renal failure and 8% anoemia. Each co-morbidity was more frequent among patients with HFpEF as compared to patients with HFrEF. Among patients with HFrEF, etiology was ischemic cardiomyopathy for 49%. 13%, 60%, 24% and 2% of patients were in NYHA I, II, II and IV respectively, and 71% had at least one hospitalization for decompensated heart failure. Among patients with an ejection fraction below 35% (n=253, 33%), 85% received a betablocker, 84% an ACEI or ARB, 28% received mineralo corticoid receptor antagonist. 6% received ivabradine. 18% were implanted with CRT and 30% with an ICD. At the end of the consultation, 11% were hospitalized for decompensated HF. Conclusions The OBLIC cohort provides epidemiological data from HF patients managed by private cardiologists in France. The patients’ characteristics seem to be similar to those managed in hospital, and treatment is in adequation with the last European Society of Cardiology guidelines. The authors hereby declare no conflict of interest
712 Predicting mortality in heart failure: derivation of a simple mortality risk score in French outpatients K. Solecki (1), C. Duflos* (2), G. Mercier (2), F. Roubille (1) (1) CHU Montpellier, Cardiologie, Montpellier, France – (2) CHU Montpellier, DIM, Montpellier, France *Corresponding author: [email protected] Introduction Cardiologists need to assess the mortality risk of their patients with heart failure (HF). The delay of one year is especially important for the indication of complex therapeutic procedures. The Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) validated a precise score, but its complexity prevents cardiologists to use it in clinical settings.
Archives of Cardiovascular Diseases Supplements (2017) 9, 29-45
685 The prevalence and characteristics of pulmonary hypertension and its prognosis value in chronic systolic heart failure: about 30106 cases from the Ibn Rochd-HF registry F. Sabri*, M. Abelhad, R. Habbal CHU Ibn Rochd, Cardiologie, Casablanca, Maroc *Corresponding author: [email protected]
The authors hereby declare no conflict of interest
031
Purpose Pulmonary hypertension (PH) is a predictor of mortality and morbidity in patients with chronic heart failure (HF) but it is poorly described in our population. We sought to study, the prevalence, determinants, and prognostic significance of PH in a large representative population with HF. Methods We retrospectively studied 30106 patients with chronic heart failure on the HF Registry of the university hospital Ibn Rochd Casablanca. Systolic pulmonary artery pressure PASP was determined by echocardiography, pulmonary hypertension was defined as PAPS >35 mmHg. Results we have enrolled 1753 patients in whom we could measure the PASP, the proportion of patients with PASP >35, ≥40, ≥45, and ≥50 mmHg was: 39,8%; 35,4%; 27%; 19,5% respectively. PH was present in 698/1753 patient, with an average age of 66 years, there was 61% women and 39% men, 79% of patients had low LVEF (left ventricular ejection fraction) and only 5,15% had preserved LVEF. The ischemic etiology of HF was predominant (48%). Most patients were receiving diuretics (66, 33%), beta-blockers (58, 16%) and ACE inhibitor (86, 22%), whereas 55, 10% were on Spironolactone. The etiology of PH was mostly due to the left heart disease, while only 2 cases was due to primary HP and 4,58% patient had COPD (Chronic obstructive pulmonary disease). Patients with PH had a rate of 28% of AHFD (acute heart failure decompensation) occurrence. Conclusion PH is common in HF patients; which is associated with worse LV function and provide incremental prognostic information. Thus, the estimation of PASP should be considered in the standard assessment of ambulatory HF patients and we must study it as a therapeutic way, to improve the management and prognosis of this population. The authors hereby declare no conflict of interest
657 Precipitating factors of cardiac decompensation in an African cardiological setting in patients suffering of heart failure I. Coulibaly*, D. Bamba, E. Soya, M. Zoumenou Institut de Cardiologie d'Abidjan, Médecine, Abidjan, Côte d'ivoire *Corresponding author: [email protected] Introduction Exacerbations of heart failure appear frequently associated with precipitating factors not directly related to the evolution of cardiac disease. In Sub-Saharan Africa there is a scarcity of data about those factors during the course of heart failure. Purpose The aim of this study was to examine prospectively the precipitating factors leading to hospitalization in patients with heart failure and to analyze the link between them in our medical ward. We evaluated any patient above 18 years admitted in our division for decompensate heart failure and identified the main precipitating factors for each patient. We included 160 patients and precipitating factors were identified in 149 (93.1%). Noncompliance with prescribed medications (47.5%), Bronchitis (34, 4%), Lack of adherence to the diet regimen (23.1%), appeared to be the most frequent precipitating factors in our setting. Arrhythmias (15%), Anemia (12.5%), progression of renal failure (7, 5%), uncontrolled hypertension (7%), and fever (7%) also played an important role in heart failure decompensation. In a multivariate analysis, non-compliance with drugs was strongly linked to lack of adherence to the diet regimen (OR=2.4), to fever (OR=1.97) and to uncontrolled hypertension (OR=1.88). Moreover lack of adherence to diet regimen was strongly linked to anemia (OR=2.2). Conclusion Large proportion heart failure hospitalizations are associated with preventable precipitating factors. In our setting the prevailing ones are the lack of adherence either to the prescribed medications or to the diet reg-
© Elsevier Masson SAS. All rights reserved.
imen and appeared to be strongly related one to another. There is a need to enhance the level of compliance of the patients to the diet regimen end to the medications by reinforcing their knowledge.
OBLIC: a nationwide French prospective cohort of heart failure ambulatory patients managed in private practice F. Mouquet* (1)-(2), D. Guedj-Meynier (2), G. Godin (2), T. Beard (2), M. Raphael (2), D. Attias (2), P. Tessier (2), P. Gueranger (2), L. Brottier (2), M. Abichacra (2), A. Warembourg (2), O. Hoffman (2), JP. Huberman (2), J. Gauthier (2), A. Cohen Solal (3) (1) Ramsay Générale de Santé, Hopital Privé le Bois, Lille, France – (2) Collège National des Cardiologues Français, Paris, France – (3) APHP-Hôpital Lariboisière, Cardiologie, Paris, France *Corresponding author: [email protected] Background Although private cardiologists manage the majority of patients with heart failure (HF) in France, no contemporary epidemiological data are available regarding the characteristics of these patients and the quality of care in private practice. Purpose Gathering epidemiological data and assessing the quality of care of HF patients managed in private practice. Methods A prospective cohort of HF patients was collected between January and March 2016. Private cardiologists gathered all ambulatory patients with a HF history during 2 consecutive weeks. Results A total of 1018 patients were included: 76% were managed for chronic HF with reduced ejection fraction (HFrEF) whereas 24% had history of HF with preserved ejection fraction (HFpEF). 77% had planned visits, 8% came for urgent unscheduled visits and 14% were seen after their hospitalization for decompensated HF. Mean age was 74 years (15-96). 63% among the patients were male. 61% had hypertension, 28% diabetes, 17% COPD, 14% sleep apnea, 12% chronic renal failure and 8% anoemia. Each co-morbidity was more frequent among patients with HFpEF as compared to patients with HFrEF. Among patients with HFrEF, etiology was ischemic cardiomyopathy for 49%. 13%, 60%, 24% and 2% of patients were in NYHA I, II, II and IV respectively, and 71% had at least one hospitalization for decompensated heart failure. Among patients with an ejection fraction below 35% (n=253, 33%), 85% received a betablocker, 84% an ACEI or ARB, 28% received mineralo corticoid receptor antagonist. 6% received ivabradine. 18% were implanted with CRT and 30% with an ICD. At the end of the consultation, 11% were hospitalized for decompensated HF. Conclusions The OBLIC cohort provides epidemiological data from HF patients managed by private cardiologists in France. The patients’ characteristics seem to be similar to those managed in hospital, and treatment is in adequation with the last European Society of Cardiology guidelines. The authors hereby declare no conflict of interest
712 Predicting mortality in heart failure: derivation of a simple mortality risk score in French outpatients K. Solecki (1), C. Duflos* (2), G. Mercier (2), F. Roubille (1) (1) CHU Montpellier, Cardiologie, Montpellier, France – (2) CHU Montpellier, DIM, Montpellier, France *Corresponding author: [email protected] Introduction Cardiologists need to assess the mortality risk of their patients with heart failure (HF). The delay of one year is especially important for the indication of complex therapeutic procedures. The Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) validated a precise score, but its complexity prevents cardiologists to use it in clinical settings.