Florent Laveau1, Nadjib Hammoudi2, Emmanuelle Berthelot3, Joël Belmin4, Patrick Assayag3, Ariel Cohen5, Thibaud Damy6, Denis Duboc7, Olivier Dubourg8, Albert Hagege9, Olivier Hanon10, Richard Isnard2, Guillaume Jondeau11, Florian Labouree4, Damien Logeart12, Nicolas Mansencal8, Christophe Meune13, Eric Pautas4, Yves Wolmark14, Michel Komajda2. 1. Université Paris 6, institut de cardiologie (AP-HP), centre hospitalier universitaire Pitié-Salpêtrière, institute of Cardiometabolism and Nutrition (ICAN), Inserm UMRS 1166, 75013 Paris, France. Electronic address: florent.laveau@psl.aphp.fr. 2. Université Paris 6, institut de cardiologie (AP-HP), centre hospitalier universitaire Pitié-Salpêtrière, institute of Cardiometabolism and Nutrition (ICAN), Inserm UMRS 1166, 75013 Paris, France. 3. Bicêtre Hospital, 94270 Le Kremlin-Bicêtre, France. 4. Charles-Foix Hospital, 94200 Ivry-sur-Seine, France. 5. Saint-Antoine Hospital, 75012 Paris, France. 6. Henri-Mondor Teaching Hospital, UPEC, 94010 Créteil, France. 7. Cochin Hospital, 75014 Paris, France. 8. Ambroise-Paré Hospital, 92100 Boulogne-Billancourt, France. 9. Georges-Pompidou European Hospital, 75015 Paris, France. 10. Broca Hospital, 75013 Paris, France. 11. Bichat-Claude-Bernard Hospital, 75018 Paris, France. 12. Lariboisière Hospital, 75475 Paris, France. 13. Avicenne Hospital, 93000 Bobigny, France. 14. Bretonneau Hospital, 75018 Paris, France.
Abstract
BACKGROUND: Hospitalization for worsening/acute heart failure is increasing in France, and limited data are available on referral/discharge modalities. AIM: To evaluate patients' journeys before and after hospitalization for this condition. METHODS: On 1 day per week, between October 2014 and February 2015, this observational study enrolled 260 consecutive patients with acute/worsening heart failure in all 10 departments of cardiology and four of the departments of geriatrics in the Greater Paris University Hospitals. RESULTS: First medical contact was an emergency unit in 45% of cases, a general practitioner in 16% of cases, an emergency medical ambulance in 13% of cases and a cardiologist in 13% of cases; 78% of patients were admitted directly after first medical contact. In-hospital stay was 13.2±11.3 days; intensive care unit stay (38% of the population) was 6.4±5 days. In-hospital mortality was 2.7%. Overall, 63% of patients were discharged home, whereas 21% were transferred to rehabilitation units. A post-discharge outpatient visit was made by only 72% of patients within 3 months (after a mean of 45±28 days). Only 53% of outpatient appointments were with a cardiologist. CONCLUSION: Emergency departments, ambulances and general practitioners are the main points of entry before hospitalization for acute/worsening heart failure. Home discharge occurs in two of three cases. Time to first patient post-discharge visit is delayed. Therefore, actions to improve the patient journey should target primary care physicians and emergency structures, and efforts should be made to reduce the time to the first visit after discharge.
BACKGROUND: Hospitalization for worsening/acute heart failure is increasing in France, and limited data are available on referral/discharge modalities. AIM: To evaluate patients' journeys before and after hospitalization for this condition. METHODS: On 1 day per week, between October 2014 and February 2015, this observational study enrolled 260 consecutive patients with acute/worsening heart failure in all 10 departments of cardiology and four of the departments of geriatrics in the Greater Paris University Hospitals. RESULTS: First medical contact was an emergency unit in 45% of cases, a general practitioner in 16% of cases, an emergency medical ambulance in 13% of cases and a cardiologist in 13% of cases; 78% of patients were admitted directly after first medical contact. In-hospital stay was 13.2±11.3 days; intensive care unit stay (38% of the population) was 6.4±5 days. In-hospital mortality was 2.7%. Overall, 63% of patients were discharged home, whereas 21% were transferred to rehabilitation units. A post-discharge outpatient visit was made by only 72% of patients within 3 months (after a mean of 45±28 days). Only 53% of outpatient appointments were with a cardiologist. CONCLUSION: Emergency departments, ambulances and general practitioners are the main points of entry before hospitalization for acute/worsening heart failure. Home discharge occurs in two of three cases. Time to first patient post-discharge visit is delayed. Therefore, actions to improve the patient journey should target primary care physicians and emergency structures, and efforts should be made to reduce the time to the first visit after discharge.
Authors: Floris Pieter Vlaanderen; Yvonne de Man; Jesse H Krijthe; Marit A C Tanke; A S Groenewoud; Patrick P T Jeurissen; Sabine Oertelt-Prigione; Marten Munneke; Bastiaan R Bloem; Marjan J Meinders Journal: Front Neurol Date: 2019-07-30 Impact factor: 4.003