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A french heart failure management program : A comparative study

F Dany,P Virot,C Daragon,F Dalmay,PM Preux and all Icarlim network members. A french heart failure management program : A comparative study . BACKROUND *Multidisciplinary systems for Heart Failure pts : grade A recommendations (ESC 2010) *Systems heterogeneity...

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A french heart failure management program : A comparative study

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  1. F Dany,PVirot,CDaragon,FDalmay,PM Preux and all Icarlim network members A french heart failure management program : A comparative study

  2. BACKROUND • *Multidisciplinary systems for Heart Failure pts • : grade A recommendations (ESC 2010) • *Systems heterogeneity... • *Necessity of regular evaluation • *Results applicable in real life ??

  3. METHODS • * 3 Hospitals : 210 Patients (pt) • * Retrospective study • · Each pt with HF following a pt included in the ICARLIM network • · was selected as a control pt

  4. ICARLIM PTS: • *2 hours Education • *3 hours dietetic formation • *Home regular follow-up • -pt’s nurse 40 times /year • -regular diet ,drugs workshops

  5. · A trend to a reduction of mortality for educated patients ( - 19%) (p<0.10) • · A significant mortality reduction by multivariate analysis if taking account the ejection fraction (OR 0.39,p=0.018) • · Only a transcient reduction of rehospitalization rate (NS) but the time to the first rehospitalization is longer for educated patients:241 days vs 192 days (p<0.05)

  6. CONCLUSION: • · problems with the method: a comparison between HF pts selected for the network and non selected shows recruitement bias :pts in network have a more severe disease • · A positive effect of multisdisciplinary system in terms of mortality, but disappointing results for rehospitalization. • · The best performance of the system for rehospitalizations is around the 6 first months

  7. ABSTRACT • A multidisciplinary management system for patients (Pts) with severe heart failure (HF)needs periodical evaluation, despite the consensus of the guidelines. It appears difficult, now, to continue with randomized prospective studies. We, then, have tried to evalue our network, comparing each active patient hospitalized for HF , included in the system (A pts) to the following HF pt, not included as a control group (C ).The study compared retrospectively 110 A pts to 101 C pts. • Results: 1/the comparison between the two groups show that, in the real life , pts selected for a disease management system were slightly younger than the control pts(76,7 vs 77,9 NS), they have a more severe HF ( EF 37,69 vs 46,82; p 0,09);they were more often diabetics (41% vs 34%) and in atrial fibrillation (66% vs 51%) • 2/despite these differences, the mortality of A group was 19% lower at one year (45/109 vs 45/88 with 13 lost in view for C Group ; p00,9) (Fig 1) • 3/In contrast the rehospitalization rate (fig 2 ) was a little higher (1OO stays vs 77; NS) but with a tendancy of less réhospitalisations during the six first month, explaining that the time to the first rehospitaliszation was longer in A group than in C group (241 days vs 193) • Conclusion : the present study confirm that a comparative evaluation of the outcomes of HF patients included in management systems, remains difficult , because of selection bias; However, it reflects the reality of our behavior ,and trends to demonstrate ,a positive effect of the system in terms of mortality, but only a transcienteffet on rehospitalization rate.

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