title: Patient journey in decompensated heart failure: An analysis in departments of cardiology and geriatrics in the Greater Paris University Hospitals.
abstract: BACKGROUND
  Hospitalization for worsening/acute heart failure is increasing in France, and limited data are available on referral/discharge modalities.
  
  
  OBJECTIVE
  To evaluate patients' journeys before and after hospitalization for this condition.
  
  
  METHODS
  On 1 day per week, between October 2014 and February 2015, this observational study enrolled 260 consecutive patients with acute/worsening heart failure in all 10 departments of cardiology and four of the departments of geriatrics in the Greater Paris University Hospitals.
  
  
  RESULTS
  First medical contact was an emergency unit in 45% of cases, a general practitioner in 16% of cases, an emergency medical ambulance in 13% of cases and a cardiologist in 13% of cases; 78% of patients were admitted directly after first medical contact. In-hospital stay was 13.2±11.3 days; intensive care unit stay (38% of the population) was 6.4±5 days. In-hospital mortality was 2.7%. Overall, 63% of patients were discharged home, whereas 21% were transferred to rehabilitation units. A post-discharge outpatient visit was made by only 72% of patients within 3 months (after a mean of 45±28 days). Only 53% of outpatient appointments were with a cardiologist.
  
  
  CONCLUSIONS
  Emergency departments, ambulances and general practitioners are the main points of entry before hospitalization for acute/worsening heart failure. Home discharge occurs in two of three cases. Time to first patient post-discharge visit is delayed. Therefore, actions to improve the patient journey should target primary care physicians and emergency structures, and efforts should be made to reduce the time to the first visit after discharge.
authors.affiliation: Université Paris 6, institut de cardiologie (AP-HP), centre hospitalier universitaire Pitié-Salpêtrière, institute of Cardiometabolism and Nutrition (ICAN), Inserm UMRS 1166, 75013 Paris, France. Electronic address: florent.laveau@psl.aphp.fr.
authors.forename: Florent
authors.initials: F
authors.lastname: Laveau
authors.affiliation: Université Paris 6, institut de cardiologie (AP-HP), centre hospitalier universitaire Pitié-Salpêtrière, institute of Cardiometabolism and Nutrition (ICAN), Inserm UMRS 1166, 75013 Paris, France.
authors.forename: Nadjib
authors.initials: N
authors.lastname: Hammoudi
authors.affiliation: Bicêtre Hospital, 94270 Le Kremlin-Bicêtre, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Berthelot
authors.affiliation: Charles-Foix Hospital, 94200 Ivry-sur-Seine, France.
authors.forename: Joël
authors.initials: J
authors.lastname: Belmin
authors.affiliation: Bicêtre Hospital, 94270 Le Kremlin-Bicêtre, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Assayag
authors.affiliation: Saint-Antoine Hospital, 75012 Paris, France.
authors.forename: Ariel
authors.initials: A
authors.lastname: Cohen
authors.affiliation: Henri-Mondor Teaching Hospital, UPEC, 94010 Créteil, France.
authors.forename: Thibaud
authors.initials: T
authors.lastname: Damy
authors.affiliation: Cochin Hospital, 75014 Paris, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Duboc
authors.affiliation: Ambroise-Paré Hospital, 92100 Boulogne-Billancourt, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Dubourg
authors.affiliation: Georges-Pompidou European Hospital, 75015 Paris, France.
authors.forename: Albert
authors.initials: A
authors.lastname: Hagege
authors.affiliation: Broca Hospital, 75013 Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Hanon
authors.affiliation: Université Paris 6, institut de cardiologie (AP-HP), centre hospitalier universitaire Pitié-Salpêtrière, institute of Cardiometabolism and Nutrition (ICAN), Inserm UMRS 1166, 75013 Paris, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Isnard
authors.affiliation: Bichat-Claude-Bernard Hospital, 75018 Paris, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Jondeau
authors.affiliation: Charles-Foix Hospital, 94200 Ivry-sur-Seine, France.
authors.forename: Florian
authors.initials: F
authors.lastname: Labouree
authors.affiliation: Lariboisière Hospital, 75475 Paris, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Logeart
authors.affiliation: Ambroise-Paré Hospital, 92100 Boulogne-Billancourt, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mansencal
authors.affiliation: Avicenne Hospital, 93000 Bobigny, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Meune
authors.affiliation: Charles-Foix Hospital, 94200 Ivry-sur-Seine, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Pautas
authors.affiliation: Bretonneau Hospital, 75018 Paris, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Wolmark
authors.affiliation: Université Paris 6, institut de cardiologie (AP-HP), centre hospitalier universitaire Pitié-Salpêtrière, institute of Cardiometabolism and Nutrition (ICAN), Inserm UMRS 1166, 75013 Paris, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Komajda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances; D000553:Ambulatory Care; D016507:Cardiology Service, Hospital; D019091:Critical Pathways; D004636:Emergency Service, Hospital; D005260:Female; D058006:General Practice; D005853:Geriatrics; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006748:Hospital Departments; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010297:Paris; D010343:Patient Admission; D010351:Patient Discharge; D010360:Patient Transfer; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Heart failure; Hospitalisation; Hospitalization; Insuffisance cardiaque; Journey; Outcomes; Parcours de soins; Patient; Pronostic