Mise en place du programme PRADO Insuffisance Cardiaque : perception par les professionnels de santé et les patients

Abstract : One of the issues in the management of heart failure (HF), whose prevalence increases with age, is the desire to reduce re-hospitalizations and deaths. These are particularly high during the first month following hospitalization for HF, thus justifying close monitoring at the end of hospitalization. Thus, several programs have been proposed in recent years, including the Home Improvement Support Program (PRADO) Heart Failure, mandated by the CPAM (Health Insurance). The objectives of this program are to reduce the re-hospitalization and death of HF patients on the one hand and to improve their quality of life on the other. This is a monocentric observational retrospective study whose main objective was to evaluate the feeling of general practitioners and nurses in the implementation of the PRADO HF program for the management of their cardiac insufficiency patients. from hospitalization. The secondary objectives were, on the one hand, to determine the impact of the PRADO protocol on the number of re-hospitalizations and deaths within 6 months following hospitalization for heart failure. It was also to evaluate the feelings of the patients included in the program. 60 physicians and 36 nurses participated in our study as well as 56 patients with an average age of 81.4 [± 9.6 years]. Regarding the knowledge of the protocol, it concerned only 28% of general practitioners and 80% of cardiologists with a significant difference between specialties. The majority of health professionals seem to favor this program, suggesting that follow-up should be adapted to the patient (co-morbidities, environment). The 6-month re-hospitalization rate for all causes was 52.7% and HF 21.6%. Among the triggering factors for re-hospitalization within 6 months, none of them corresponded to a therapeutic break or a difference in diet, suggesting that the therapeutic education sessions of the PRADO program were productive. We also found a trend toward shorter re-hospitalizations, although the results were not significant. In addition, mortality at 6 months following hospitalization for heart failure was 18.2%. Older age (greater than 85 years) was associated with a high prevalence of re-hospitalization and was statistically associated with a higher risk of death. No significant relationship could be identified with respect to the biological (BNP), ultrasound (LVEF) and educational (number of sessions performed under the PRADO protocol) criteria. Regarding the quality of life of patients the majority of them reported having felt a benefit to carry out this program, a fortiori because it was accessible in its content and easy to set up at home. The low rate of awareness of the program should allow for new effective means of dissemination for this type of program as the prevalence of HF will continue to grow in the coming years.
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Submitted on : Wednesday, November 28, 2018 - 10:05:23 AM
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Sophia Warrak. Mise en place du programme PRADO Insuffisance Cardiaque : perception par les professionnels de santé et les patients. Sciences du Vivant [q-bio]. 2018. ⟨dumas-01937334⟩



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