Laveau Florent, Hammoudi Nadjib, Berthelot Emmanuelle, Belmin Joël, Assayag Patrick, Cohen Ariel, Damy Thibaud, Duboc Denis, Dubourg Olivier, Hagege Albert, Hanon Olivier, Isnard Richard, Jondeau Guillaume, Labouree Florian, Logeart Damien, Mansencal Nicolas, Meune Christophe, Pautas Eric, Wolmark Yves, Komajda Michel
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.
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.
Arch Cardiovasc Dis. 2017 Jan;110(1):42-50. doi: 10.1016/j.acvd.2016.05.009. Epub 2016 Dec 21.
Hospitalization for worsening/acute heart failure is increasing in France, and limited data are available on referral/discharge modalities.
To evaluate patients' journeys before and after hospitalization for this condition.
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.
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.
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.
在法国，因心力衰竭加重/急性心力衰竭而住院的情况日益增多，而关于转诊/出院方式的数据有限。
评估此类疾病患者住院前后的就医过程。
在2014年10月至2015年2月期间，每周选取1天，这项观察性研究纳入了大巴黎大学医院所有10个心内科以及4个老年病科的260例连续的急性/心力衰竭加重患者。
首次医疗接触是在急诊科的占45%，是在全科医生处的占16%，是通过急救医疗救护车的占13%，是在心内科医生处的占13%；78%的患者在首次医疗接触后直接入院。住院时间为13.2±11.3天；入住重症监护病房的患者（占总人数的38%）住院时间为6.4±5天。住院死亡率为2.7%。总体而言，63%的患者出院回家，而21%的患者被转至康复机构。仅72%的患者在3个月内（平均45±28天之后）进行了出院后门诊复诊。门诊预约中只有53%是预约的心内科医生。
急诊科、救护车和全科医生是急性/心力衰竭加重患者住院前的主要就医途径。三分之二的患者出院回家。患者出院后首次复诊时间延迟。因此，改善患者就医过程的行动应针对基层医疗医生和急救机构，并应努力缩短出院后首次就诊的时间。
