Good Performance in the Management Of

Berthelot et al. BMC Geriatrics (2021) 21:288 https://doi.org/10.1186/s12877-021-02210-0 RESEARCH Open Access Good performance in the management of acute heart failure in cardiogeriatric departments: the ICREX-94 experience Emmanuelle Berthelot1,2*, Amaury Broussier3,4, Thibaud Damy3,5, Cristiano Donadio1,2,6, Stephane Cosson7, Xavier Rovani7, Emmanuel Salengro8, Gilles Billebeau8, Richard Megbemado9, Noomen Rekik9, Christian Godreuil10, Kevin Richard11, Jason Shourick12, Patrick Assayag1,2, Joel Belmin6, Jean Philippe David3,13, Luc Hittinger3,5 and for the FINC-94 network Abstract Context: A growing number of elderly patients hospitalized for Acute Heart Failure (AHF) are being managed in cardiogeriatrics departments, but their characteristics and prognosis are poorly known. This study aimed to investigate the profile and outcome (rehospitalization at 90 days) of patients hospitalized for AHF in cardiogeriatrics departments in the Val-de-Marne area in the suburbs of Paris, and to compare them to AHF patients hospitalized in cardiology departments in the same area. Methods: Observational study, ICREX-94, conducted in seven cardiology departments in France and three specific cardiogeriatrics departments in Val-de-Marne. Results: A total of 308 patients were hospitalized for AHF between October 2017 and January 2019. During the 90 days following discharge, 29.6% patients were readmitted to the hospital. Compared with patients hospitalized in cardiology departments, patients in cardiogeriatrics departments were older (p < 0.001), less independent (living more often alone or in an institution) (p < 0.001), more often depressed (p < 0.001), had more often major neurocognitive disorder (p < 0.001), had a higher Human Development Index (HDI, p < 0.001), and were less often diagnosed with amyloidosis (p < 0.001). There was no difference in outcome whether patients were discharged from cardiology or cardiogeriatrics departments. The most frequent precipitating factors underlying AHF decompensation between the first and second hospitalization were arrhythmia and infection. Conclusion: AHF patients discharged from cardiogeriatrics departments, compared to cardiology departments, showed clinical differences but had the same prognosis regarding AHF rehospitalization at 90 days. Keywords: Heart failure, Cardiogeriatrics, Prognosis, Profile, Risk factors * Correspondence: [email protected] 1Université Paris Sud, Le Kremlin-Bicêtre, France 2APHP, Department of Cardiology, Hopital Bicêtre, 78, rue du général Leclerc, 94270 Le Kremlin Bicêtre, France Full list of author information is available at the end of the article © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Berthelot et al. BMC Geriatrics (2021) 21:288 Page 2 of 11 Introduction cardiogeriatrics units in the Val-de-Marne department Heart failure is a disease that affects about 2% of the (zip code 94) in France. population in western countries [1, 2]. With the aging The present study was conducted in the Val-de- population, the prevalence of acute heart failure (AHF), Marne department: 245 sq. km, 1.4 million inhabi- measured as the annual incidence of hospitalizations for tants, a mix of residential cities and low-incomes cit- AHF, rises to more than 10% in patients over 70 years of ies (mean HDI 0.58, max 0.78, min 0.35). The Val- age [3]. de-Marne health system comprises 48 hospitals, with After discharge from the hospital for AHF, readmis- a total capacity of 9500 beds. In 2018, in the 10 hos- sions are frequent [4, 5]. Although overall hospitalization pitals participating in this study, 2393 heart failure rates for heart failure have decreased, unplanned read- admissions were recorded by the “Caisse Primaire missions continue to be a common occurrence, with d’Assurance Maladie” (Frenchhealthinsurancefund), nearly 30% of patients being readmitted within 90 days representing 85% of all AHF admissions in Val-de- of discharge [6, 7]. Among older patients, hospitalization Marne. In 2016, ten Val-de-Marne cardiology and is associated with markedly adverse outcomes, including cardiogeriatrics departments, academic and non- increased mortality, morbidity, and health care expendi- academic, public and private, large and small, inter- tures [8]. ested in HF care, decided to create a network Often, heart failure patients are older than 75 years (FINC94) and to collaborate, in order to share their and have other common geriatric conditions including experiences, train healthcare professionals and con- frailty, depression, cognitive impairment, malnutrition, duct clinical studies such as this one [20]. disabilities, and chronic diseases other than a heart con- There were seven classical cardiology departments, dition [9, 10]. The management of these patients de- found in both teaching and nonteaching hospitals, public pends on geriatrics and cardiology particularities. and private, and three cardiogeriatrics departments spe- Cardiologists’ and geriatricians’ awareness and percep- cialized in heart failure management, with geriatricians tion of heart failure, comorbidities and functional status who had received specific academic and practical train- can be different and complementary [11]. Indeed, the ing in cardiovascular medicine. In addition to their geri- intervention of cardiologists in the course of care for atrics background, the geriatricians in these units trained elderly patients has been shown to improve short-term for several months in cardiology departments specialized mortality and readmission outcomes [12, 13]. Calls have in HF, and have university diplomas in echocardiography been made for a new paradigm in cardiac care for older and cardiovascular disease of elderly patients. Therefore, adults or for closer collaboration between the two speci- they work in close cooperation with the HF team of their alities [14, 15]. No study has yet established the contri- departments. There was no specific protocol when pa- bution to HF care of geriatricians with expertise in tients were hospitalized in cardiology or cardiogeriatrics cardiology. departments, except to follow 2016 ESC guidelines on Some studies have focused on the profile of patients at HF. Upon admission to cardiogeriatrics departments, an risk of being rehospitalized [16, 17], and other studies individual and multidisciplinary approach (by geriatri- have looked at precipitating factors that trigger acute cians, physiotherapists, dietitians and social workers) heart failure [18, 19]. In the context of hospitalization in was established, focused on stabilization of comorbidi- cardiology and cardiogeriatrics units, the various factors ties, return to self-sufficiency and renutrition in addition influencing rehospitalization are not clearly established. to specific cardiology follow-up. We hypothesized that the geriatric conditions of pa- There were no specific guidelines to direct patients to tients hospitalized for AHF could impact the rate and a cardiology or cardiogeriatrics department. precipitating factors of rehospitalization. Consecutive patients over 18 years of age, hospitalized The objectives of this study were (i) to determine the for acute HF and alive at discharge were eligible for the profile and outcome (rehospitalization at 90 days) of study. Diagnosis of AHF was based on signs and patients admitted to Val-de-Marne hospitals for HF, symptoms of HF— clinical point of view, BNP at admis- depending on whether they were hospitalized in a car- sion > 100 pg/ml and heart structure suggesting HF on diology or a specialized cardiogeriatrics department and echocardiograms, as recommended (ESC guidelines). (ii) to analyze modes and precipitating factors of Patients who did not understand the French language rehospitalization in the two types of departments. were excluded. The study was compliant with Helsinki rules and was approved by the local ethics committee Methods (Commission éthique et déontologie de la Faculté de The ICREX-94 research was a prospective, non- Médecine Paris-Saclay #20181128163709). All patients interventional, observational, transversal, multicentric gave their informed consent. Informed consent was registry conducted in seven cardiology units and three obtained for all the participants. Berthelot et al. BMC Geriatrics (2021) 21:288 Page 3 of 11 Table 1 Baseline characteristics of all patients depending on department (cardiology or cardiogeriatrics) Department Overall Cardiogeriatrics Cardiology p N (%) 308 66 (21.4) 242 (78.6) Age, yrs. 75.8 ± 13.5 82.4 ± 9.2 74.0

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