De 14h30 à 14h45 - OFICA · Pacing, IAD 18%, 4% Baseline characteristics. Non CV coNon CV co-...
Transcript of 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
Pattern of inclusionsPattern of inclusionsPattern of inclusionsPattern of inclusions
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%
Pattern of inclusionsPattern of inclusionsPattern of inclusionsPattern of inclusions
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
IC. à 95% de Odds Ratio Pr > ChiSq
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%
InInInIn----hospital deathshospital deathshospital deathshospital deaths
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
InInInIn----hospital deathshospital deathshospital deathshospital deaths
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 .
InInInIn----hospital deathshospital deathshospital deathshospital deaths
Multivariate stepwise analysisMultivariate stepwise analysisMultivariate stepwise analysisMultivariate stepwise analysis
Paramètre Mortalite àl hôpital
Odds Ratio
IC. à 95% de 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
InInInIn----hospital deathshospital deathshospital deathshospital deaths
Multivariate stepwise analysisMultivariate stepwise analysisMultivariate stepwise analysisMultivariate stepwise analysis
En enlevant les patients « infectés » (n = 440)
ParamètresMortalite à
l hôpitalOdds Ratio
IC. à 95% de Odds 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%
FollowFollowFollowFollow----up after dischargeup after dischargeup after dischargeup after discharge
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
FollowFollowFollowFollow----up after dischargeup after dischargeup after dischargeup after discharge
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) ………………………………………………..
OObbsseerrvvaattooii rree OOFFIICCAA
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
OObbsseerrvvaattooii rree OOFFIICCAA
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 : …………………………………………………………………….
OObbsseerrvvaattooii rree OOFFIICCAA
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
UnivariateUnivariateUnivariateUnivariateanalysisanalysisanalysisanalysis
(ANOVAou Fisher)
InInInIn----hospital deathshospital deathshospital deathshospital deaths
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?
UnivariateUnivariateUnivariateUnivariateanalysisanalysisanalysisanalysis
InInInIn----hospital deathshospital deathshospital deathshospital deaths
Multivariate stepwise analysisMultivariate stepwise analysisMultivariate stepwise analysisMultivariate stepwise analysis
ParamètreMortalite à
l hôpitalOdds Ratio
IC. à 95% de Odds Ratio Pr > ChiSq
Critère AIC
Age décès 1.024 [1.0053 ; 1.0426] 0.0114 658.771
FEVG (%) décès 0.982 [0.9678 ; 0.9956] 0.0102 .
Antécédents d’ ICA décès 1.585 [1.0352 ; 2.4277] 0.0341 .
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
InInInIn----hospital deathshospital deathshospital deathshospital deaths
Multivariate stepwise analysisMultivariate stepwise analysisMultivariate stepwise analysisMultivariate stepwise analysis
Paramètre
Mortalite à l
hôpitalOdds Ratio
IC. à 95% de Odds Ratio
Pr > ChiSq
Critère AIC
BNP24h / NTProBNP24h en quartiles décès 1.363 [1.0456 ; 1.7775] 0.0221 663.299
Antécédents d’ ICA décès 1.592 [1.0404 ; 2.4367] 0.0322 .
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
InInInIn----hospital deathshospital deathshospital deathshospital deaths
Multivariate stepwise analysisMultivariate stepwise analysisMultivariate stepwise analysisMultivariate stepwise analysis
En enlevant les patients « infectés » (n = 440)
Paramètre Mortalite à l hôpital
Odds Ratio
IC. à 95% de 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)
Survival after dischargeSurvival after dischargeSurvival after dischargeSurvival after discharge
CRP admission > 60mg/l
CRP admission < 60m
Logrank test p = 0.044
Survival after dischargeSurvival after dischargeSurvival after dischargeSurvival after discharge
QRS < 120msec
QRS > 120msec
Logrank test p = 0.035
non-sinusal
sinusal
Logrank test p = 0.0086
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)