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Master Thesis

Le parcours de soins du patient insuffisant cardiaque chronique entre deux hospitalisations pour décompensation aiguë: identification des difficultés de la prise en charge ambulatoire

Abstract : Introduction: heart failure (HF) is a frequent and serious chronic pathology, whose evolution is peppered with decompensations that usually require hospitalization. Understanding and structuring the management of HF appears as a public health issue. Objective: characterize the care pathway between two hospitalisations for acute heart failure (AHF). Methods: this was a prospective unicentric study in Libourne’s hospital. A data sheet was collected on the care pathway, the treatment undertaken, the knowledge of their heart disease, the clinical and biological characteristics of patients with AHF in cardiology, geriatry and internal medecine. The primary endpoint was the nature of the pathways followed by patients, the secondary endpoints were the time between first symptoms and medical care’s, the treatments administered, the clinical and biological profile of patients and diagnostic test. Results: between 2018-10-01 and 2019-05-31, 66 patients were included. The average age was 78.4 years, there were 56% of men. 56% of patients had a treatment recommanded for HF. Median length between two hospitalizations was 5 months. Time between first symptoms and consultation was 5 days. Median length of stay was 14.5 days. Ischemic heart disease was the main cause of AHF (43.9%). In 54.5% of patients, we didn’t find a triggering factor of AHF. 31.8% of patients already had a therapeutic education. 44% related knowing the first symptoms of ICA. Standard dosage was gradually increased in 60% of the discharge prescription. 69.7% of patients returned home. An appointment with a cardiologist was scheduled in post hospitalization in 56% of cases and 60.6% of cases with their family doctor. Conclusion: this study highlights gaps. Therapeutic education needs to be optimized, deadlines betwwen first clinical symptoms and medical care’s must be shorten. Identifying care pathway should enable enhanced monitoring and improving the prognosis and decrease early rehospitalization.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02531377
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Submitted on : Friday, April 3, 2020 - 4:15:26 PM
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Romane Mirieu de Labarre. Le parcours de soins du patient insuffisant cardiaque chronique entre deux hospitalisations pour décompensation aiguë: identification des difficultés de la prise en charge ambulatoire. Médecine humaine et pathologie. 2020. ⟨dumas-02531377⟩

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