Only 59 % of patients with heart failure consult a cardiologist once a year, the minimum recommended. This observation was established by Dr. Guillaume Baudry and Pr Nicolas Girerd (Pierre Drouin clinical investigation center, in Nancy), from the National Health Data System (SNDS).
Two criteria to better classify the severity of heart failure
To improve the situation, the authors offer a track to guide the monitoring of patients, based on two simple criteria allowing to assess the severity of the disease: the presence of a history of hospitalization and its seniority, as well as the prescription of diuretics of the handle – which act on a specific part of the kidney called Henle handle to eliminate water, sodium and chloride.
These drugs are both markers of the severity of heart failure and at the origin of serious adverse effects: excessive decrease in the volume of blood circulating/ hypovolemia, too low sodium in the blood/ hyponatremia, acute renal failure, etc.
This approach makes it possible to define four categories of patients, each associated with a specific monitoring frequency. Because today, the pace of patient who insufficient cardiac consultations is left to the practitioner’s appreciation.
The frequency of monitoring impacts survival
To test and apply their severity criteria, and because “the association between monitoring and prognosis according to the level of risk was not described at the population level”, the authors relied on a French cohort of more than 650,000 patients, that is all French patients identified as with heart failure in the previous five years. This population was divided into four groups according to the severity of heart failure.
After a year, the mortality rate all causes reached 16 %. It was less than 8 % in the less severely affected patients, and up to 25 % for the most severe. Compared to the less severe, the relative risk of mortality was more than doubled in the most severe (multiplied by 2.32).
Severe patients are not necessarily more followed
Whatever the level of severity, all categories are poorly followed: around 40 % of patients do not consult their cardiologist once a year, with a median of two consultations only on the five years of follow -up. However, the authors also showed that going to this annual consultation reduced the mortality of 6 to 9 points.
Another worrying observation: the management of heart failure remains insufficient, with a rate that is still low of drugs, however essential, such as the antagonists of mineralocorticoid receptors (they block the deleterious effects of aldosterone, a hormone involved in the retention of sodium and water by the kidneys, and reduce mortality).
The authors conclude in favor of optimal monitoring of an annual cardiological consultation for the least severe patients, and up to four for the most serious. And from 2 to 3 in case of intermediate severity. “A simple stratification, based on the history of hospitalization and the use of diuretics of the handle, makes it possible to effectively predict the prognosis,” they explain. “Adapting the pace of cardiological consultations to this classification would optimize resources and reduce preventable mortality. »»
