CP023 - Enquête REZICA : parcours de soin des patients atteints pris en charge pour insuffisance cardiaque aiguë. Résultats préliminaires.

Frederic Adnet (1), Denis Angoulvant (2), Yves Lambert (3), Benedicte Gourieux (4), Louis Soulat (5), Yves Cottin (6), Patrick Jourdain (7), Yves Juilliere (8)

1. Urgences - samu 93, Hopital Avicenne, 93000 Bobigny, Bobigny, France 2. Cardiologie, Hopital Trousseau, Tours, France 3. Samu, Hopital de Versailles, Versailles, France 4. Cardiologie, CHU de strasbourg, strasbourg, France 5. Samu, Hopital Chateauroux, Chateauroux, France 6. Cardiologie, Hopital du Bocage, Dijon, France 7. Cardiologie, CH de Pontoise, Pontoise, France 8. Cardiologie, CHU Nancy, Nancy, France

Diffusion le 11/05/2017

/medias/images/design/icos/eposters.png /medias/images/design/icos/resumes.png


Introduction

Le parcours hospitalier des patients souffrants d’insuffisance cardiaque aiguë (ICA) n’a jamais été analysé. La multiplicité des filières pourrait influer la morbi-mortalité.

Objectif

Caractériser les parcours pré-hospitaliers et hospitaliers de patients présentant des symptômes d’ICA.

Méthodes

Enquête prospective, multicentrique nationale, de suivi d’une cohorte. Réalisation d’une fiche de recueil de données sur le parcours, les traitements entrepris, les caractéristiques cliniques et biologiques et sur la mortalité hospitalière de patients atteints d’ICA. Les données étaient collectées prospectivement dans chaque centre. Le critère d’évaluation principal était la nature des filières suivies par les patients. Les critères secondaires concernaient les traitements administrés, le profil clinique et biologique des patients et la mortalité hospitalière.

Résultats

Entre le 1/6/2014 et le 1/5/2016, 1.822 patients ont été inclus dans 24 centres. L’âge moyen était de 78 ans et il y avait 52% d’hommes. La durée médiane des séjours était de 7 jours et 16 heures. Soixante-treize pour cent des patients étaient pris en charge aux urgences, les soins intensifs de cardiologie représentaient 29% et les services de cardiologie, 68%. Seize pour cent des patients étaient initialement pris en charge par un Smur. La filière la plus représentée était l’admission directe aux urgences précédant un service conventionnel. La cardiologie représentait 74% des hospitalisations conventionnelles. L’appel au Samu représentait 24% de la cohorte. Le délai entre l’apparition des symptômes et l’entrée dans une filière hospitalière était de plus de 3 jours. La pression artérielle moyenne à l’admission était de 96 ±19 mmHg et la fréquence cardiaque de 91 ±26/min. La moitié des patients avait une fraction d’éjection du ventricule gauche inférieure à 40%. Un tiers des patients présentait une dysfonction rénale. Aux urgences, il y avait un traitement par oxygène dans 83% des cas, des diurétiques 87%, les vasodilatateurs 26% et des inotropes 2%. La ventilation non invasive était utilisée dans 17% des cas. La mortalité hospitalière était de 8% (142 patients).

Conclusion

Cette enquête nationale a pu identifier les différents parcours des patients atteints d’ICA. Les urgences et les services de cardiologies conventionnelles sont les plus sollicités. Le recrutement se poursuit afin d’identifier des pistes d’optimisation du parcours de prise en charge des patients atteints d’ICA.

Tags : insuffisance cardiaque filieres hospitalieres

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/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Expr.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Profiler.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Select.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Statement.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Statement/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Statement/Pdo.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Table.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Table/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Table/Definition.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Exception.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Inflector.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/PregReplace.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/StringToLower.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Word/CamelCaseToDash.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Word/CamelCaseToSeparator.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Word/Separator/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Word/SeparatorToSeparator.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Word/UnderscoreToSeparator.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Layout.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Layout/Controller/Action/Helper/Layout.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Layout/Controller/Plugin/Layout.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Loader.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Loader/Autoloader.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Loader/PluginLoader.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Loader/PluginLoader/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Locale.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Locale/Data.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Locale/Format.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Locale/Math.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log/FactoryInterface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log/Filter/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log/Filter/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log/Filter/Priority.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log/Writer/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Registry.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session/Exception.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session/Namespace.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session/SaveHandler/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Uri.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Version.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Doctype.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/HeadMeta.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/HeadTitle.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Layout.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Container.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Container/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Container/Standalone.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Registry.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Url.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Interface.php

ZFDebug Files

/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Cache.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Database.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Exception.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/File.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Log.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Log/Writer.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Text.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Variables.php