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French annual national observational study of 2015 outpatient and inpatient healthcare utilization by approximately half a million patients with previous heart failure diagnosis.

法国年度国家观察研究2015年门诊和住院医疗保健利用约50万患者既往诊断为心力衰竭。

  • 影响因子:2.06
  • DOI:10.1016/j.acvd.2020.05.009
  • 作者列表:"Feldman SF","Lesuffleur T","Olié V","Gastaldi-Ménager C","Juillière Y","Tuppin P
  • 发表时间:2021-01-01
Abstract

BACKGROUND:Heart failure management guidelines have been published, but the degree of adherence to these guidelines remains unknown. AIMS:To study in 2015 healthcare utilization and causes of death for people previously identified with heart failure. METHODS:The national health data system was used to identify adult general scheme (86% of the French population) hospitalized for heart failure between 2011 and 2014 or with only a long-term chronic disease allowance for heart failure. The frequency and median (interquartile range) of at least one healthcare use among those still alive in 2015 was calculated. RESULTS:A total of 499,296 adults (1.4% of the population) were included, and 429,853 were alive in 2015; median age 79 (68-86) years. At least one utilization was observed for a general practitioner in 95% of patients (median 8 [interquartile range 5-13] consultations), a cardiologist in 42% (2 [1-3]), a nurse in 78% (16 [4-100]), a loop diuretic in 64% (11 [8-12] dispensations), an aldosterone antagonist in 21% (8 [5-11]), a thiazide in 15% (7 [4-11]), a renin-angiotensin system inhibitor in 68% (11 [8-13]), a beta-blocker in 65% (11 [7-13]), a beta-blocker plus a renin-angiotensin system inhibitor in 57%, and a beta-blocker plus a renin-angiotensin system inhibitor plus an aldosterone antagonist in 37%. Hospitalization for heart failure was present for 8% (1 [1,2]). Higher levels of healthcare utilization were observed in the presence of hospitalization for heart failure before 2015. Among the 13.9% of people who died in 2015, heart failure accounted for 8% of causes, cardiovascular disease accounted for 39%. CONCLUSIONS:General practitioners and nurses are the main actors in the regular follow-up of patients with heart failure, whereas cardiologist consultations and dispensing of first-line treatments are insufficient with respect to guidelines.

摘要

背景: 心力衰竭管理指南已经发表,但是对这些指南的遵守程度仍然未知。 目的: 研究在2015年的医疗保健利用和死亡原因的人以前确定与心脏衰竭。 方法: 使用国家健康数据系统确定2011年至86% 年间因心力衰竭住院的成人一般方案 (占法国人口的2014) 或仅因心力衰竭的长期慢性病津贴。计算了2015年仍然存活的患者中至少一次医疗保健使用的频率和中位数 (四分位距)。 结果: 共纳入499,296名成年人 (占人口的1.4%),2015年存活429,853人; 中位年龄79 (68-86) 岁。在95% 的患者 (中位数8 [四分位距5-13] 咨询) 中观察到全科医生的至少一次利用,在42% (2 [1-3]) 中观察到心脏病专家,在78% (16 [4-100]) 中观察到护士,袢利尿剂在64% (11 [8-12] 分配),醛固酮拮抗剂在21%(8 [5-11]),15% 的噻嗪类 (7 [4-11]),68% 的肾素-血管紧张素系统抑制剂 (11 [8-13]),65% 的 β 受体阻滞剂 (11 [7-13]),57% 为 β 受体阻滞剂加肾素-血管紧张素系统抑制剂,37% 为 β 受体阻滞剂加肾素-血管紧张素系统抑制剂加醛固酮拮抗剂。因心力衰竭住院8% (1 [1,2])。在2015年之前,在因心力衰竭住院治疗的情况下,观察到更高的医疗利用率。在2015年死亡的13.9% 人中,心力衰竭占原因的8%,心血管疾病占39%。 结论: 全科医生和护士是心力衰竭患者定期随访的主要参与者,而心脏病专家咨询和一线治疗的分配相对于指南是不够的。

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