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Brite session: Dealing with difficult situations in primary care

Brite session: Dealing with difficult situations in primary care. Camille De Franceschi Cabinet Médical Marcel Monny Lobe, Soisy-sous-Montmorency, France. The case of Mr M. 80 years old.

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Brite session: Dealing with difficult situations in primary care

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  1. Brite session:Dealing with difficult situations in primary care Camille De Franceschi Cabinet Médical Marcel Monny Lobe, Soisy-sous-Montmorency, France

  2. The case of Mr M. 80 years old • High blood pressure, ischemic heart disease and arrhythmia (AF under oral anticoagulant), hyperlipidaemia, chronic renal failure, Chronic Obstructive Pulmonary Disease, weaned smoking. • He complained of an increase dyspnea, as well as a recent "orthopnea", and lower limb oedema with a limited walking. • Clinically, the patient had a NYHA stage III, TA: 150/90 mmHg, an irregular heart beat (75/min), crackles at both lung bases, and major bilateral lower limb oedema (weight:+3kg) • Biologically BNP was increased to 800. • Heart Echography: reduced left ventricular ejection fraction • Mr M. refused to be addressed in hospital and wished to be managed at home by his family physician.

  3. Questions: • Do we insist by explaining and convincing Mr M to be hospitalised (hopefully in cardiology bypassing the emergency unit)?

  4. Conditions associated with a poor prognosis in heart failure European Society of Cardiology, Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: Eur Heart J 2008;29(19):2388-442.

  5. Questions: • Are there some professional risk of litigation by managing at home?

  6. Questions: • What is the optimal management organisation to set up?- for the acute phase?- for the follow up and rehabilitation phases?

  7. Questions: • What do we advocate for an ambulatory management of difficult situations in Primary Care? • How could we rethink our practices?

  8. The End… Thank you for your attention

  9. The evidence base • European Society of Cardiology: Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P,and al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: European Heart Journal 2008;29(19):2388-442. • European Society of Cardiology: John J.V. McMurray, S. Adamopoulos, S. D. Anker, and all. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: European Heart Journal 2012; 33: 1787–1847. • Haute Autorité de Santé (french medical authority) : Heart Failure Recommendations

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