de 14h30 à 14h45 - ofica · pacing, iad 18%, 4% baseline characteristics. non cv conon cv co-...

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(French survey on acute heart failure)(French survey on acute heart failure)(French survey on acute heart failure)(French survey on acute heart failure)(French survey on acute heart failure)(French survey on acute heart failure)(French survey on acute heart failure)(French survey on acute heart failure)

Damien Damien Damien Damien LogeartLogeartLogeartLogeart, Paris, Paris, Paris, Paris

on on on on behalfbehalfbehalfbehalf of the French of the French of the French of the French WorkingWorkingWorkingWorking Group on Group on Group on Group on HeartHeartHeartHeart FailureFailureFailureFailure

Grants from Menarini and Servier

METHODMETHODMETHODMETHOD

� Inclusion: Inclusion: Inclusion: Inclusion: allallallall hospitalizedhospitalizedhospitalizedhospitalized patients in patients in patients in patients in participatingparticipatingparticipatingparticipating centerscenterscenterscenters, , , , admittedadmittedadmittedadmitted beforebeforebeforebefore or on 12 March 2009,or on 12 March 2009,or on 12 March 2009,or on 12 March 2009,withwithwithwith acute HF as main acute HF as main acute HF as main acute HF as main diagnosisdiagnosisdiagnosisdiagnosis on admission, on admission, on admission, on admission, whateverwhateverwhateverwhatever the type or the type or the type or the type or severityseverityseverityseverity of HFof HFof HFof HF

� Exclusion: Exclusion: Exclusion: Exclusion: plannedplannedplannedplanned hospitalisation, hospitalisation, hospitalisation, hospitalisation, cardiaccardiaccardiaccardiac surgerysurgerysurgerysurgery settingsettingsettingsetting� Data collection Data collection Data collection Data collection

�12th March 2009 and 12th March 2009 and 12th March 2009 and 12th March 2009 and atatatat dischargedischargedischargedischarge, by local , by local , by local , by local investigatorinvestigatorinvestigatorinvestigator((((diagnosisdiagnosisdiagnosisdiagnosis of HF of HF of HF of HF confirmedconfirmedconfirmedconfirmed atatatat dischargedischargedischargedischarge by local by local by local by local investigatorinvestigatorinvestigatorinvestigator))))

� FollowFollowFollowFollow----up up up up afterafterafterafter dischargedischargedischargedischarge atatatat 3 and 12 3 and 12 3 and 12 3 and 12 monthsmonthsmonthsmonths

�� """"SSSSnapshotnapshotnapshotnapshot" on " on " on " on March 12th, 2009March 12th, 2009March 12th, 2009March 12th, 2009

RESULTSRESULTSRESULTSRESULTSRESULTSRESULTSRESULTSRESULTS

DOM TOM : 2

Picardie

Alsace

Franche -Comté

Bretagne

Pays deLoire

Basse -Normandie

Haute -Normandie

Poitou -Charentes

Aquitaine

Midi-Pyrénées 10

Languedoc -Roussillon 6

Provence -Alpes -Côte d’Azur

Rhône-Alpes

BourgogneCentre

Limousin

Lorraine

Auvergne22

4

5

1

68

3

12

5

4

8

6

11

6

7

12

42

Nord-Pas -de-Calais

Champagne -Ardennes

4

Ile -de-France

170 participating hospitals170 participating hospitals170 participating hospitals170 participating hospitals1869 screened patients1869 screened patients1869 screened patients1869 screened patients�1830 included patients1830 included patients1830 included patients1830 included patients

(confirmed AHF diagnosis)(confirmed AHF diagnosis)(confirmed AHF diagnosis)(confirmed AHF diagnosis)

1 to 44 patients / hospital1 to 44 patients / hospital1 to 44 patients / hospital1 to 44 patients / hospital

Pattern of inclusionsPattern of inclusionsPattern of inclusionsPattern of inclusions

General hospital (n=109)

Universitary hospital (n=40)

Private hospital (n=21)

56%

35%8%

Patients (%) per type of hospital

Cardiac surgery

+ intervent. cardiology (n=39)

Intervent. cardiol (n=55)

Without (n=76)

36%

34%29%

According to type of facilitiesAccording to type of funding


Patients (%) per medical department at inclusionPatients (%) per medical department at inclusionPatients (%) per medical department at inclusionPatients (%) per medical department at inclusion

Cardiology wardCardiology wardCardiology wardCardiology ward58%58%58%58%

Others (ICUOthers (ICUOthers (ICUOthers (ICU…………))))8%8%8%8%EmergencyEmergencyEmergencyEmergency

department (UHCD) 1%department (UHCD) 1%department (UHCD) 1%department (UHCD) 1%

Internal medicineInternal medicineInternal medicineInternal medicine15%15%15%15%

Cardiac ICU Cardiac ICU Cardiac ICU Cardiac ICU 18%18%18%18%


Hypertensive AHF 2%Shock 6 %

Acute pulmonary edema

38%

Decompensated HF

48%

Right HF 6 %

Clinical scenariosClinical scenariosClinical scenariosClinical scenarios

De novo HF: 37% cases

Previous AHF: 45% cases

Age (years)Age (years)Age (years)Age (years) 76 ± 13 (median 79)Male Male Male Male 55 %Systolic BP (mmHg)Systolic BP (mmHg)Systolic BP (mmHg)Systolic BP (mmHg) 130.2 ± 29.3Heart rate (bpm)Heart rate (bpm)Heart rate (bpm)Heart rate (bpm) 89.2 ± 29.4Body Mass IndexBody Mass IndexBody Mass IndexBody Mass Index 27.4 ± 6.3LVEF LVEF LVEF LVEF

> 0.50 ; 0.41-0.50 ; ≤ 0.400.42 ± 0.16

30% ; 19% ; 52%Ischemic diseaseIschemic diseaseIschemic diseaseIschemic disease 44% (documented CAD in 75%¨)

HypertensionHypertensionHypertensionHypertension 70%

Creat clearance (ml/min)Creat clearance (ml/min)Creat clearance (ml/min)Creat clearance (ml/min)30-59 ml/min< 30ml/min

59.3 ± 66.047%15%

BNP or NTproBNP (pg/ml)BNP or NTproBNP (pg/ml)BNP or NTproBNP (pg/ml)BNP or NTproBNP (pg/ml)(obtained in 82% cases)

3000 ± 1563;10687 ± 12583

Atrial fibrillationAtrial fibrillationAtrial fibrillationAtrial fibrillation 27.4%Pacing, IAD Pacing, IAD Pacing, IAD Pacing, IAD 18%, 4%

Baseline characteristicsBaseline characteristicsBaseline characteristicsBaseline characteristics

Non CV coNon CV coNon CV coNon CV co----morbiditiesmorbiditiesmorbiditiesmorbidities

% cases% cases% cases% cases≥ 2 comorbidity : 38% cases2 comorbidity : 38% cases2 comorbidity : 38% cases2 comorbidity : 38% cases

≥ 3 comorbidities : 29% cases3 comorbidities : 29% cases3 comorbidities : 29% cases3 comorbidities : 29% cases

≥ 4 comorbidities: 12% cases4 comorbidities: 12% cases4 comorbidities: 12% cases4 comorbidities: 12% cases

Precipitating factorsPrecipitating factorsPrecipitating factorsPrecipitating factors

% cases% cases% cases% cases

Intensive (cardiac) care unitIntensive (cardiac) care unitIntensive (cardiac) care unitIntensive (cardiac) care unit 41.9%EchocardiographyEchocardiographyEchocardiographyEchocardiography 81.5%Coronary angiographyCoronary angiographyCoronary angiographyCoronary angiography 20.7% IV diureticsIV diureticsIV diureticsIV diuretics 86.2 %NonNonNonNon----invasive ventilationinvasive ventilationinvasive ventilationinvasive ventilationInvasive ventilationInvasive ventilationInvasive ventilationInvasive ventilation

12. 0%5.7%

Inotropic drugsInotropic drugsInotropic drugsInotropic drugs 13.2%Circulatory support deviceCirculatory support deviceCirculatory support deviceCirculatory support device 1.7% (15 IABP, 7 ECMO,

4 ventricular assist devices)

Ultrafiltration/dialysisUltrafiltration/dialysisUltrafiltration/dialysisUltrafiltration/dialysis 2.5%Pacing; IADPacing; IADPacing; IADPacing; IAD 4.4%; 0.9%RevascularisationRevascularisationRevascularisationRevascularisation 6%

Hospital managementHospital managementHospital managementHospital management

Duration of hospitalisation (d)Duration of hospitalisation (d)Duration of hospitalisation (d)Duration of hospitalisation (d) 12.2 ± 6.5 [1 – 36]} Blood pressure (mmHg)Blood pressure (mmHg)Blood pressure (mmHg)Blood pressure (mmHg) 119.0 ± 20.8Heart rate (bpm)Heart rate (bpm)Heart rate (bpm)Heart rate (bpm) 74.1 ± 14.5Loss of weight (kgs)Loss of weight (kgs)Loss of weight (kgs)Loss of weight (kgs)informed in 56% of cases

-4.36 ± 6.8 (median: -3)

Creat clearance (ml/min/1.73mCreat clearance (ml/min/1.73mCreat clearance (ml/min/1.73mCreat clearance (ml/min/1.73m²²²²))))Worsening renal function Worsening renal function Worsening renal function Worsening renal function ((((↗↗↗↗ creat > 25creat > 25creat > 25creat > 25µµµµM)M)M)M)informed in 81% of cases

52.7 ± 23.021.9%

Hemoglobin (g/dl)Hemoglobin (g/dl)Hemoglobin (g/dl)Hemoglobin (g/dl)informed in 70% of cases

12.2 ± 1.9

BNP or NTproBNP (pg/ml) BNP or NTproBNP (pg/ml) BNP or NTproBNP (pg/ml) BNP or NTproBNP (pg/ml) informed in 35% of cases

907; 4852

PrePrePrePre----dischargedischargedischargedischarge

All patientsAll patientsAll patientsAll patients LVEF LVEF LVEF LVEF ≤ 40%40%40%40% LVEF ≤ 40%% target dose% target dose% target dose% target dose

DiureticsDiureticsDiureticsDiuretics 84.0%84.0%84.0%84.0% 87.6%87.6%87.6%87.6% 138 ± 613mg/dACEACEACEACE----IIII 53.1%53.1%53.1%53.1% 64.3%64.3%64.3%64.3% 43 ± 27 %ARBARBARBARB 11.9%11.9%11.9%11.9% 9.8%9.8%9.8%9.8% 42 ± 28 %ACEACEACEACE----I / ARBI / ARBI / ARBI / ARB 64.7%64.7%64.7%64.7% 73.5%73.5%73.5%73.5%BetablockersBetablockersBetablockersBetablockers 53.5%53.5%53.5%53.5% 65.7%65.7%65.7%65.7% 36 ± 44%ACEACEACEACE----I/ARB + BBI/ARB + BBI/ARB + BBI/ARB + BB 39.039.039.039.0 51.7%51.7%51.7%51.7%Aldosterone blockersAldosterone blockersAldosterone blockersAldosterone blockers 17.5%17.5%17.5%17.5% 25.2%25.2%25.2%25.2%Digitalis 9.4% 9.3%Calcium blockers 17.1% 8.5%Amiodarone 22.3% 23.3%Aspirin; Anticoagulants

44.8%; 43.0%

51.5%; 49.2%

HF network, HF clinic HF network, HF clinic HF network, HF clinic HF network, HF clinic or rehabilitation centeror rehabilitation centeror rehabilitation centeror rehabilitation center

4.0%4.0%4.0%4.0% 6.2%6.2%6.2%6.2%

Treatment at dischargeTreatment at dischargeTreatment at dischargeTreatment at discharge

Parameters associated with the lack Parameters associated with the lack Parameters associated with the lack Parameters associated with the lack Parameters associated with the lack Parameters associated with the lack Parameters associated with the lack Parameters associated with the lack of HFof HFof HFof HFof HFof HFof HFof HF--------treatmentstreatmentstreatmentstreatmentstreatmentstreatmentstreatmentstreatments

(in patients with LVEF (in patients with LVEF (in patients with LVEF (in patients with LVEF ≤ 0.40)0.40)0.40)0.40)

Paramètre

Traitement IEC ou ARA2

à la sortieOdds Ratio

IC. à 95% de Odds Ratio Pr > ChiSq

Age oui 0.981 [0.9642 ; 0.9973] 0.0230

BNP24h / NTProBNP en quartiles oui 1.496 [1.098 ; 2.0383] 0.0107

FEVG tertiles oui 1.694 [1.0989 ; 2.6107] 0.0170

Clairance à l'admission oui 1.017 [1.0074 ; 1.0262] 0.0004

ACEACEACEACE----I or ARBI or ARBI or ARBI or ARB

Paramètre

Traitement BB à la sortie Odds Ratio


BPCO oui 0.632 [0.5123 ; 0.9014] <.0001

Age oui 0.982 [0.9647 ; 0.9925] 0.005

Ischémique oui 1.345 [1.214 ; 2.1425] 0.011

BetaBetaBetaBeta----blockersblockersblockersblockers

InInInIn----hospital deathshospital deathshospital deathshospital deaths

Cardiovascular causeCardiovascular causeCardiovascular causeCardiovascular cause

8.3 % 8.3 % 8.3 % 8.3 % (n = 138)(n = 138)(n = 138)(n = 138)

81.2%81.2%81.2%81.2%Age Age Age Age ≥ 79 years79 years79 years79 yearsAge < 79 yearsAge < 79 yearsAge < 79 yearsAge < 79 years

10.9 %10.9 %10.9 %10.9 %6.5 %6.5 %6.5 %6.5 %

LVEF < 50%LVEF < 50%LVEF < 50%LVEF < 50%LVEF LVEF LVEF LVEF ≥ 50%50%50%50%

9.5%9.5%9.5%9.5%5.9%5.9%5.9%5.9%

ShockShockShockShockNo shockNo shockNo shockNo shock

18.1%18.1%18.1%18.1%7.9%7.9%7.9%7.9%


According to different hospitalsAccording to different hospitalsAccording to different hospitalsAccording to different hospitals

ParamètreCHU

N = 599

CHG

N = 934

Centres privés

N = 107p

Age (ans) 74.4 77.8 74.9 < 0.001

Passage en USIC 46.7% 39.5% 51% 0.02

Etat de choc 9.7% 3.9% 2.8% <0.001

FEVG (%)

FEVG ≥ 50%

FEVG ≤ 30%

3932%

41%

4439%

27%

41

35%

38%

<0.0010.025

<0.0001

PA syst admission (mmHg)

125 132 132 <0.001

Décès intrahospitalier

9.5% 7.6% 12.5% 0.15


Multivariate stepwise analysisMultivariate stepwise analysisMultivariate stepwise analysisMultivariate stepwise analysisAvecAvecAvecAvec : : : : Age , AntAge , AntAge , AntAge , Antééééccccéééédent ddent ddent ddent d’’’’ICA , Choc cardio , FEVGValeur , PA admission ,ICA , Choc cardio , FEVGValeur , PA admission ,ICA , Choc cardio , FEVGValeur , PA admission ,ICA , Choc cardio , FEVGValeur , PA admission ,

BNP admission, clairance crBNP admission, clairance crBNP admission, clairance crBNP admission, clairance crééééatatatat

Paramètre Mortalite àl hôpital

Odds Ratio

IC. à 95% de Odds Ratio

Pr > ChiSq

Critère AIC

BNP24h / NTProBNP24h (quartiles) décès 1.344 [1.0303 ; 1.7536] 0.0293 646.504

Pression artérielle systol (mmHg) décès 0.983 [0.9749 ; 0.9911] <.0001 .

Clairance créatinine à l'admission décès 0.986 [0.9766 ; 0.9947] 0.0020 .


Multivariate stepwise analysisMultivariate stepwise analysisMultivariate stepwise analysisMultivariate stepwise analysis

Paramètre Mortalite àl hôpital

Odds Ratio


Pr > ChiSq

Critère AIC

Age décès 1.022 [1.0021 ; 1.0432] 0.0308 532.340

CRP (mg/L) décès 1.003 [1.0004 ; 1.0066] 0.0268 .

FEVG (%) décès 0.979 [0.9634 ; 0.9945] 0.0082 .

Antécédents d’ ICA décès 1.975 [1.221 ; 3.1938] 0.0055 .

Pression artérielle systol (mmHg) décès 0.983 [0.974 ; 0.9924] 0.0004 .

AvecAvecAvecAvec : : : : Age , AntAge , AntAge , AntAge , Antééééccccéééédent ddent ddent ddent d’’’’ICA, ChocCardiogen , FEVGValeur , PA admissio , ICA, ChocCardiogen , FEVGValeur , PA admissio , ICA, ChocCardiogen , FEVGValeur , PA admissio , ICA, ChocCardiogen , FEVGValeur , PA admissio , BNP admission, clairance crBNP admission, clairance crBNP admission, clairance crBNP admission, clairance crééééat, at, at, at, CRP admission*CRP admission*CRP admission*CRP admission*

* renseign* renseign* renseign* renseignéééée chez 84% des patientse chez 84% des patientse chez 84% des patientse chez 84% des patients



En enlevant les patients « infectés » (n = 440)

ParamètresMortalite à

l hôpitalOdds Ratio


Pr > ChiSq

Critère AIC

Age Décès 1.027 [1.0045 ; 1.0501] 0.0184 444.638

CRP (mg/L) Décès 1.007 [1.0024 ; 1.0112] 0.0025 .

FEVG <30/30-50/>50 Décès 0.669 [0.4708 ; 0.9511] 0.0251 .

Pression artérielle systol (mmHg) Décès 0.976 [0.9655 ; 0.986] <.0001 .

Clairance à l'admission Décès 0.988 [0.977 ; 0.9991] 0.0342 .

FollowFollowFollowFollow----up after dischargeup after dischargeup after dischargeup after discharge

1519 survivors with follow1519 survivors with follow1519 survivors with follow1519 survivors with follow----up up up up (91% of all survivors)(91% of all survivors)(91% of all survivors)(91% of all survivors)

One year of followOne year of followOne year of followOne year of follow----up up up up ---- deaths (data for 1519 patients)deaths (data for 1519 patients)deaths (data for 1519 patients)deaths (data for 1519 patients)---- hospitalisations (data for 826)hospitalisations (data for 826)hospitalisations (data for 826)hospitalisations (data for 826)---- use of medical resources (350)use of medical resources (350)use of medical resources (350)use of medical resources (350)

OneOneOneOne----year rate of year rate of year rate of year rate of deathsdeathsdeathsdeaths

Causes informed in 55%Causes informed in 55%Causes informed in 55%Causes informed in 55%Sudden deathSudden deathSudden deathSudden deathHeart failureHeart failureHeart failureHeart failureOther CV causesOther CV causesOther CV causesOther CV causesNon CV causeNon CV causeNon CV causeNon CV cause

30.9% 30.9% 30.9% 30.9% (n = 469)(n = 469)(n = 469)(n = 469)

N= 259N= 259N= 259N= 25916%16%16%16%56%56%56%56%8%8%8%8%19%19%19%19%


All cause deathsAll cause deathsAll cause deathsAll cause deaths

Age ≤ 75 y

Age > 75 y

Logrank test p < 0.001

One yearOne yearOne yearOne year----survival after dischargesurvival after dischargesurvival after dischargesurvival after discharge

Pas de betabloqueur

Bétabloqueur à la sortie

Covariate P HR 95% CI

Age <0,0001 1,055 1,034 - 1,077

Hemoglobine de sortie 0,0340 0,888 0,796 - 0,990

Creatininemie de sortie 0,0416 1,022 1,001 - 1,043

FC de sortie 0,0159 1,016 1,003 - 1,030

PA systolique de sortie 0,0122 0,988 0,978 - 0,997

BNP ou NTproBNP 0,0015 1,325 1,114 - 1,575

Cox proportionnalCox proportionnalCox proportionnalCox proportionnal----hazards regression (stepwise) analysishazards regression (stepwise) analysishazards regression (stepwise) analysishazards regression (stepwise) analysis

OneOneOneOne----year survival after dischargeyear survival after dischargeyear survival after dischargeyear survival after discharge

Non prNon prNon prNon préééédictifs en multivaridictifs en multivaridictifs en multivaridictifs en multivariéééé : sexe, FEVG, tableau clinique initial, SCA, : sexe, FEVG, tableau clinique initial, SCA, : sexe, FEVG, tableau clinique initial, SCA, : sexe, FEVG, tableau clinique initial, SCA, ischischischischéééémique, infection, CRP, AC/FA, traitement sortiemique, infection, CRP, AC/FA, traitement sortiemique, infection, CRP, AC/FA, traitement sortiemique, infection, CRP, AC/FA, traitement sortie

OneOneOneOne----year rate of 1st year rate of 1st year rate of 1st year rate of 1st rehospitalisationsrehospitalisationsrehospitalisationsrehospitalisations

Heart failureHeart failureHeart failureHeart failure

2 readmissions2 readmissions2 readmissions2 readmissions3 readmissions3 readmissions3 readmissions3 readmissions≥ 4 readmissions4 readmissions4 readmissions4 readmissions

Mean delay (days)Mean delay (days)Mean delay (days)Mean delay (days)Median (days)Median (days)Median (days)Median (days)

56.0% 56.0% 56.0% 56.0% n = 463n = 463n = 463n = 463

n= 212 (??)n= 212 (??)n= 212 (??)n= 212 (??)

939393937171717118181818

13813813813891919191


Hospitalisations (reported in 826 pts)Hospitalisations (reported in 826 pts)Hospitalisations (reported in 826 pts)Hospitalisations (reported in 826 pts)

Special thanks !Special thanks !Special thanks !Special thanks !

• 170 local investigators170 local investigators170 local investigators170 local investigators• French working group on Heart FailureFrench working group on Heart FailureFrench working group on Heart FailureFrench working group on Heart Failure• French Society of Cardiology (research unit)French Society of Cardiology (research unit)French Society of Cardiology (research unit)French Society of Cardiology (research unit)• CollCollCollCollèèèège National des Cardiologues des ge National des Cardiologues des ge National des Cardiologues des ge National des Cardiologues des

Hôpitaux GHôpitaux GHôpitaux GHôpitaux Géééénnnnéééérauxrauxrauxraux• Menarini and Servier (grants)Menarini and Servier (grants)Menarini and Servier (grants)Menarini and Servier (grants)

OObbsseerrvvaattooii rree OOFFIICCAA

SFC – Groupe de Travail « Insuf f isance Cardiaque »

FICHE D’ADMISSION N° Centre investigateur : ………………………………. N° Patient : ………………………………………………

Initiales du Patient : ……………………………

AADDMMIISSSSIIOONN

Service : � USIC � Cardiologie (où vous incluez le patient) � Médecine interne � Gériatrie � Unité d’hospitalisation courte aux urgences � Autre : ……………………………………. Date d’admission dans le service : / / jj/mm/aaaa Mode d’admission, parcours de soins en amont de l’admission Date d’admission à l’hôpital : / / jj/mm/aaaa

Acteurs et structures ayant intervenu dans l’admission (préciser l’ordre d’intervention dans les cases, le cas échéant)

� Généraliste

� Cardiologue

� Centre 15

� SMUR / Pompier

� Service d’accueil des urgences

� Unité d’hospitalisation de courte durée

� Réanimation médicale

� USIC

� Service à préciser ……………………………….

� Service à préciser ………………………………. � Autre (préciser) : …………………………..…………….…. Motif initial d’admission à l’hôpital : � Insuffisance Cardiaque � de novo � aggravation d’une IC préexistante � Syndrome coronaire aigu ST+ ou Syndrome coronaire ST- � Arythmie � Autre cause (préciser) …………………..……………..

Présentation clinique de l’ICA : � Œdème pulmonaire � Insuffisance cardiaque globale � Insuffisance cardiaque hypertensive � Choc cardiogénique � Insuffisance cardiaque droite � Autre (préciser) ………………………………………………..


SFC – Groupe de Travail « Insuf f isance Cardiaque »

FICHE D’INCLUSION

Nom du centre investigateur : ……………………………………..………………………………………………….……………………..…….

Docteur : ……………………………………………………………………………………………………………………………………..…………………………

N° Centre investigateur : …………………………………………………………………………………………………….……………...…………….

IIDDEENNTTIIFFIICCAATTIIOONN PPAATTIIEENNTT

N° Patient : …………………………………… (préattribué)

Nom : Prénom :

Nom de jeune fille :

Date de Naissance : / / jj/mm/aaaa

Lieu de Naissance : Ville : Code Postal :

Sexe : � Homme � Femme

Adresse :

Code Postal : Ville :

N° Téléphone : N° Portable :

ou N° Téléphone (Personne de confiance) :

MMEEDDEECCIINN RREEFFEERREENNTT

Nom : Prénom :

Adresse :

Code Postal : Ville :

N° Téléphone :

A nous retourner par courrier ou par Fax au 01.43.22.63.61


SFC – Groupe de Travail « Insuf fisance Cardiaque »

N° Centre investigateur : ………………………………. N° Patient : ………………………………………………

Initiales du Patient : ……………………………

Procédure pendant l’hospitalisation Echo coeur : � Non � Oui

Coronographie : � Non � Oui Si oui, ATL : � Non � Oui

Pace maker : � Non � Oui Si oui, type : � simple � double � BiV � DAI

Passage en USIC ou réanimation : � Non � Oui Si oui, nombre de jours ………...….…… Diurétiques IV : � Non � Oui Inotropes : � Non � Oui Si oui, préciser le nom ……………...….. Ventilation non invasive : � Non � Oui Ventilation invasive : � Non � Oui Ultrafiltration/hémodialyse : � Non � Oui

Assistance circulatoire transitoire : � Non � Oui Si oui, préciser : …………………….….. Greffe : � Non � Oui

SSOORRTTIIEE Date de sortie : / / jj/mm/aaaa Pression artérielle : - - - / - - mmHg � np Poids : kg � np systolique / diastolique Fréquence cardiaque : bpm � np ECG : � Sinusal BBG ou QRS > 120msec : � Non � AC / FA � Oui

� np

Biologie à la sortie BNP : pg/ml � np NT pro BNP : pg/ml � np Créatininémie : µmol/l mgl/l

� np

Natrémie : mmol/l � np Kalièmie : mmol/l � np Hémoglobine : g/dl

Traitement de sortie Joindre une copie de l’ordonnance

Mode de sortie � Décès � Domicile

� Hébergement temporaire avec réadaptation (centre de réadaptation)

� Hébergement temporaire sans réadaptation (maison de repos ou moyen séjour)

� Hébergement permanent (maison de retraite ou long séjour)

� Autre (préciser) : ……………………………………

Mode de suivi prévu � Médecin Généraliste � Médecin hospitalier � Unité d’IC ambulatoire / Education thérapeutique � Cardiologue libéral � Réseau d’IC � Réadaptation ambulatoire

Si Décès Date : / / jj/mm/aaaa

Cause : …………………………………………………………………….


SFC – Groupe de Travail « Insuff isance Cardiaque »

FICHE DE SUIVI HOSPITALIER ET DE SORTIE

N° Centre investigateur : ………………………………. N° Patient : ………………………………………………

Initiales du Patient : …………………………… Diagnostic d’IC confirmé � Non � Oui ( si non, ne pas remplir la suite ) Poids d’admission : kg � np Taille : cm � np

Traitement avant admission : � IEC Nom :……………… Dosage :…………….. � np � ARA 2 Nom :……………… Dosage :…………….. � np � B Bloquant Nom :……………… Dosage :…………….. � np � Diurétiques Nom :……………… Dosage :…………….. � np � Aldostérone Nom :……………… Dosage :…………….. � np � Statines Nom :……………… Dosage :…………….. � np � AVK � Clopidogrel � Aspirine

Antécédents cardiovasculaire : � Hospitalisation pour IC Si oui : � < 3 mois � 3 à 12mois � > 3 mois � IdM � Angioplastie � Pontage � AVC � Chirurgie valvulaire � PM Si oui : � simple � BiV � double � DAI

Facteurs de risque : � Tabac � HTA � Alcool � Diabète � Dyslipidémie

Comorbidités : � BPCO ou insuf. resp chronique � Dialyse � Syndrome démentiel � Néoplasie actuelle � Autre (préciser) ……………………………………………..

Etiologie(s) de la cardiopathie � HTA � Ischémique documentée par coronaro � Ischémique non documentée par coronaro � Cardiomyopathie dilatée � Cardiomyopathie infiltrative � Valvulaire � Familiale (autres cas avérés) � CMH � CMD � Autre (préciser) : ……………………………………

FEVG : % � np

Facteurs déclenchants : � SCA ST+ � SCA ST- / Troponine + � AC/FA ou TSV � Arythmies ventriculaire � Infection � Poussées hypertensives � Rupture traitement � Ecart régime � Chirurgie / Anesthésie � Indéterminé � Autre (préciser) : ……………………………………

Biologie ( uniquement dans les 24 premières heures )

BNP : pg/ml � np

NT pro BNP : pg/ml � np

Créatininémie : µmol/l ou mg/l

� np

CRP : mg/l � np

Patient (with possible AHF)Patient (with possible AHF)Patient (with possible AHF)Patient (with possible AHF)

GPGPGPGP PrivatePrivatePrivatePrivatecardiologistcardiologistcardiologistcardiologist

EmergencyEmergencyEmergencyEmergencyUnitUnitUnitUnit

PatientPatientPatientPatient’’’’s course before admissions course before admissions course before admissions course before admission

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

First consultationFirst consultationFirst consultationFirst consultation

112112112112callcallcallcall

ICUICUICUICUWardsWardsWardsWards

2222ndndndnd consultationconsultationconsultationconsultation

Emergencymedical

mobile unit(SAMU)

Admission

Number of actors/examinations before admissionNumber of actors/examinations before admissionNumber of actors/examinations before admissionNumber of actors/examinations before admission�� 1 in 18% 1 in 18% 1 in 18% 1 in 18% 2 in 39% 3 in 23% 4 in 10%2 in 39% 3 in 23% 4 in 10%2 in 39% 3 in 23% 4 in 10%2 in 39% 3 in 23% 4 in 10%

HypertensiveHypertensiveHypertensiveHypertensivecardiopathy**cardiopathy**cardiopathy**cardiopathy**

IschemicIschemicIschemicIschemiccardiopathy*cardiopathy*cardiopathy*cardiopathy*

ValvularValvularValvularValvulardisease disease disease disease

Idiopathic Idiopathic Idiopathic Idiopathic dilated dilated dilated dilated cardiocardiocardiocardio----

myopathymyopathymyopathymyopathy

OthersOthersOthersOthers

Underlying cardiac diseasesUnderlying cardiac diseasesUnderlying cardiac diseasesUnderlying cardiac diseases

43.6% 43.6% 43.6% 43.6%

34.1% 34.1% 34.1% 34.1%

16.3% 16.3% 16.3% 16.3%

22.6% 22.6% 22.6% 22.6%

15.5% 15.5% 15.5% 15.5%

*previous MI in 55%,documented CAD

in 75% cases

>1 single underlying >1 single underlying >1 single underlying >1 single underlying cardiac disease cardiac disease cardiac disease cardiac disease in 32% casesin 32% casesin 32% casesin 32% cases

** HTNin 70% cases

LVEF: 41.9 LVEF: 41.9 LVEF: 41.9 LVEF: 41.9 ± 16.3 %16.3 %16.3 %16.3 %Preserved LVEF (> 50%) in 25% patientsPreserved LVEF (> 50%) in 25% patientsPreserved LVEF (> 50%) in 25% patientsPreserved LVEF (> 50%) in 25% patients

(40% in females, 20% in males)(40% in females, 20% in males)(40% in females, 20% in males)(40% in females, 20% in males)

LV ejection fractionLV ejection fractionLV ejection fractionLV ejection fraction

Treatments (LVEF Treatments (LVEF Treatments (LVEF Treatments (LVEF ≤ 40%)40%)40%)40%)

DiureticsDiureticsDiureticsDiuretics ACEACEACEACE----IIII ARBARBARBARB ACEACEACEACE----I/I/I/I/ARBARBARBARB

BBBBBBBB AldostAldostAldostAldostblockersblockersblockersblockers

Before admissionBefore admissionBefore admissionBefore admissionDischargeDischargeDischargeDischarge

Parameters associated with the lack Parameters associated with the lack Parameters associated with the lack Parameters associated with the lack Parameters associated with the lack Parameters associated with the lack Parameters associated with the lack Parameters associated with the lack of ACEof ACEof ACEof ACEof ACEof ACEof ACEof ACE--------I/ARB at dischargeI/ARB at dischargeI/ARB at dischargeI/ARB at dischargeI/ARB at dischargeI/ARB at dischargeI/ARB at dischargeI/ARB at discharge(in patients with LVEF (in patients with LVEF (in patients with LVEF (in patients with LVEF ≤ 0.40)0.40)0.40)0.40)

ppppAgeAgeAgeAgeGender

0.00020.00020.00020.00020.12

Diabetes 0.40

Rate of coRate of coRate of coRate of co----morbidities 0morbidities 0morbidities 0morbidities 0----4444 0.0250.0250.0250.025

Ischemic vs non-ischemicAcute coronary syndrome

0.190.6

Clinical scenariosInotropic useInotropic useInotropic useInotropic use

0.080.0240.0240.0240.024

Blood Pressure on admission 0.69

LVEFLVEFLVEFLVEF 0.0160.0160.0160.016

Creat clearance (MDRD)Creat clearance (MDRD)Creat clearance (MDRD)Creat clearance (MDRD) <0.0001<0.0001<0.0001<0.0001BNP or NTproBNPBNP or NTproBNPBNP or NTproBNPBNP or NTproBNP 0.0010.0010.0010.001

CRPCRPCRPCRP 0.00010.00010.00010.0001

UnivariateUnivariateUnivariateUnivariateanalysisanalysisanalysisanalysis

Betablockers at dischargeBetablockers at dischargeBetablockers at dischargeBetablockers at dischargeBetablockers at dischargeBetablockers at dischargeBetablockers at dischargeBetablockers at discharge(in patients with LVEF (in patients with LVEF (in patients with LVEF (in patients with LVEF ≤ 0.40)0.40)0.40)0.40)

ppppAgeAgeAgeAgeGenderGenderGenderGender

0.0060.0060.0060.0060.0480.0480.0480.048

Diabetes 0.24

Rate of coRate of coRate of coRate of co----morbidities 0morbidities 0morbidities 0morbidities 0----4444BPCOBPCOBPCOBPCO

0.0210.0210.0210.021<0.001<0.001<0.001<0.001

Ischemic vs nonIschemic vs nonIschemic vs nonIschemic vs non----ischemicischemicischemicischemicAcute coronary syndromeAcute coronary syndromeAcute coronary syndromeAcute coronary syndrome

0.00180.00180.00180.00180.0520.0520.0520.052

Clinical scenariosInotropic useInotropic useInotropic useInotropic use

0.0530.0270.0270.0270.027

Blood Pressure on admission 0.82

LVEF 0.056

Creat clearance (MDRD) 0.061BNP or NTproBNPBNP or NTproBNPBNP or NTproBNPBNP or NTproBNP 0.0330.0330.0330.033

CRPCRPCRPCRP 0.0120.0120.0120.012


(ANOVAou Fisher)


ppppAgeAgeAgeAgeGender

0.01590.01590.01590.01590.72

AntAntAntAntééééccccéééédent ddent ddent ddent d’’’’ICAICAICAICA 0.01950.01950.01950.0195

Diabetes 0.0997

Rate of coRate of coRate of coRate of co----morbidities 0morbidities 0morbidities 0morbidities 0----4444 0.00060.00060.00060.0006

Cardiogenic shock (scenarios)Cardiogenic shock (scenarios)Cardiogenic shock (scenarios)Cardiogenic shock (scenarios) 0.00350.00350.00350.0035

Ischemic vs non-ischemicAcute coronary syndrome

0.330.25

Blood Pressure on admissionBlood Pressure on admissionBlood Pressure on admissionBlood Pressure on admission <0.0001<0.0001<0.0001<0.0001

LVEF continue ou < 30%; 30LVEF continue ou < 30%; 30LVEF continue ou < 30%; 30LVEF continue ou < 30%; 30----50%; >50%50%; >50%50%; >50%50%; >50% <0.0001<0.0001<0.0001<0.0001

Creat clearance (MDRD)Creat clearance (MDRD)Creat clearance (MDRD)Creat clearance (MDRD) <0.0001<0.0001<0.0001<0.0001

BNP or NTproBNPBNP or NTproBNPBNP or NTproBNPBNP or NTproBNP 0.00010.00010.00010.0001

CRPCRPCRPCRP 0.00020.00020.00020.0002

BMIBMIBMIBMI <0.01?<0.01?<0.01?<0.01?




ParamètreMortalite à

l hôpitalOdds Ratio


Critère AIC

Age décès 1.024 [1.0053 ; 1.0426] 0.0114 658.771

FEVG (%) décès 0.982 [0.9678 ; 0.9956] 0.0102 .


Pression artérielle systolique (mmhg) décès 0.985 [0.9763 ; 0.9933] 0.0005 .

Choc cardiogénique décès 1.224 [1.018 ; 1.4725] 0.0316 .

Test global de Wald.Hypothèse nulle: BETA=0 => P-value =5.2555065E-7

AvecAvecAvecAvec : : : : Age, AntAge, AntAge, AntAge, AntééééccccéééédentIC, Choc cardio, FEVGValeur, PASAdmissiondentIC, Choc cardio, FEVGValeur, PASAdmissiondentIC, Choc cardio, FEVGValeur, PASAdmissiondentIC, Choc cardio, FEVGValeur, PASAdmission



Paramètre

Mortalite à l

hôpitalOdds Ratio


Pr > ChiSq

Critère AIC

BNP24h / NTProBNP24h en quartiles décès 1.363 [1.0456 ; 1.7775] 0.0221 663.299


Pression artérielle systolique (mmhg) décès 0.984 [0.9758 ; 0.9921] 0.0001 .

Test global de Wald.Hypothèse nulle: BETA=0 => P-value =1.2325923E-6

AvecAvecAvecAvec : : : : Age , AntAge , AntAge , AntAge , AntééééccccéééédentIC , Choc cardio , FEVGValeur , dentIC , Choc cardio , FEVGValeur , dentIC , Choc cardio , FEVGValeur , dentIC , Choc cardio , FEVGValeur , PASAdmissionr, BNP_quartilPASAdmissionr, BNP_quartilPASAdmissionr, BNP_quartilPASAdmissionr, BNP_quartil



En enlevant les patients « infectés » (n = 440)

Paramètre Mortalite à l hôpital

Odds Ratio


Pr > ChiSq

Critère AIC

Age Décès 1.029 [1.0084 ; 1.0506] 0.0058 542.669

CRP repartie en quartiles Décès 1.266 [1.0287 ; 1.5572]0.0259 .

Choc cardiogénique Décès 3.350 [1.5929 ; 7.0445] 0.0014 .

FEVG <30/30-50/>50 Décès 0.710 [0.5136 ; 0.9815] 0.0382 .

Pression artérielle systol (mmhg) Décès 0.979 [0.9698 ; 0.9886] <.0001 .

Clairance à l'admission MDRD Décès 0.983 [0.973 ; 0.9934] 0.0013 .

CRPCRPCRPCRP

% patients

CRP (mg/l)

% décès

CRP (mg/l)

Population sans Population sans Population sans Population sans «««« infectioninfectioninfectioninfection »»»»

LVEF 30%LVEF 50%

Cardiogenic shock

SCA ST+

SCA ST- Tn+

PA sortie (quartiles)p = 0.0003

PA sortie ≥ 120mmHg

PA sortie < 120Logrank test p = 0.008

FC sortie < 70bpm

FC sortie ≥ 70bpmLogrank test p = 0.06

FC sortie (quartiles)p = 0.034

Creat at dischargep < 0.0001

Survival after dischargeSurvival after dischargeSurvival after dischargeSurvival after discharge

Predischarge BNP (quartiles)Logrank test p < 0.0001

Q4 (BNP > 950pg/ml)Q4 (BNP > 950pg/ml)Q4 (BNP > 950pg/ml)Q4 (BNP > 950pg/ml)


CRP admission > 60mg/l

CRP admission < 60m

Logrank test p = 0.044


QRS < 120msec

QRS > 120msec


non-sinusal

sinusal


Use of medical resourcesUse of medical resourcesUse of medical resourcesUse of medical resources

1st consultation (cardiology) = 119days1st consultation (cardiology) = 119days1st consultation (cardiology) = 119days1st consultation (cardiology) = 119days(reported in about 300 cases)1st consultation (GP) = 70 days1st consultation (GP) = 70 days1st consultation (GP) = 70 days1st consultation (GP) = 70 days(reported in about 350cases)

de 14h30 à 14h45 - ofica · pacing, iad 18%, 4% baseline characteristics. non cv conon cv co-...

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