Evaluation of heart failure management in a Military Hospital.
OBJECTIVE
Evaluate heart failure management in a Military Hospital in 2005.


METHODS
Retrospective audit of 46 case records of patients hospitalised with heart failure within the framework of an accreditation procedure.


RESULTS
The left ventricular ejection fraction was evaluated in 85% of cases during the reference hospital stay. Systolic heart failure was detected in 63% of cases. At least one NT-proBNP assay was performed for each patient. A global assessment was systematically performed, except for the mini mental state examination in patients aged over 75 years who represented 80% of patients. Initial therapeutic education was provided for 50% of systolic heart failure patients. Prescription rates in systolic heart failure were 76% for angiotensin-converting enzyme inhibitors, 7% for angiotensin receptor antagonists; 84% for at least one medicinal product in the above 2 classes; 68% for beta-blockers and 32% for spironolactone. A hospital discharge report was available for 93% of the patients. Elective re-admissions to hospital for uptitration of treatment concerned 10% of systolic heart failure patients. Emergency hospital re-admissions after a cardiovascular event (usually decompensation), concerned 35% of patients, after an average duration of one year of follow-up. These latter re-admissions, often repeated, led to 4% of additional hospital deaths. The initial hospital mortality rate was 13%.


CONCLUSIONS
Therapeutic patient education is under development. Medication may still be optimised, both qualitatively and quantitatively. Surveillance is planned with a yearly audit.
Guiraudet
O
O
Département de cardiologie, Hôpital d'Instruction des Armées Bégin, Saint-Mandé. olivierguiraudet@yahoo.fr
Lambert de Crémeur
G
G
Bonnevie
L
L
Héno
P
P
Pelletier
C
C
Fraboulet
R
R
Schiano
P
P
Martin
A-C
AC
Chenilleau
M-C
MC
Delarbre
D
D
Chanudet
X
X
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D004032:Diet; D004232:Diuretics / Q000627:therapeutic use; D004363:Drug Utilization; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D017052:Hospital Mortality; D006760:Hospitalization; D006772:Hospitals, Military; D006801:Humans; D008019:Life Style; D008485:Medical Audit; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010353:Patient Education as Topic; D010359:Patient Readmission / Q000706:statistics & numerical data; D010446:Peptide Fragments / Q000097:blood; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D013148:Spironolactone / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D004232:Diuretics; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D013148:Spironolactone