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Summary Background Despite guidelines describing the optimal diagnostic and therapeutic procedures for patients with suspected cardiac implantable electronic device (CIED) infections, their management is often challenging. Aims To describe our diagnostic and therapeutic practices for suspected CIED infection, and to compare them with European Heart Rhythm Association (EHRA) guidelines. Methods Patients hospitalized in the tertiary care Nancy University Hospital for suspected CIED infection from 2014 to 2019 were included retrospectively. We applied the EHRA classification of CIED infection, and compared diagnostic and therapeutic management with the EHRA guidelines. Results Among 184 patients (mean age 72.3 ± 12.4 years), 137 had a proven infection of the lead (by transthoracic echocardiography/transoesophageal echocardiography, 18F-fluorodesoxyglucose positron emission tomography/computed tomography or positive culture of the lead) or an isolated pocket infection without proof of lead infection, and 47 had no proof of CIED infection. According to the EHRA classification, CIED infection was considered as definite in 145 patients and possible in 31 and was excluded in eight patients. Regarding recommended diagnostic procedures, blood cultures were performed in 90.8%, transthoracic echocardiography in 97.8%, transoesophageal echocardiography in 85.9%, 18F-fluorodesoxyglucose positron emission tomography/computed tomography in 50.5% and imaging for embolisms in 78.3% of the patients. Compared with therapeutic recommendations for the 145 cases of definite CIED infection, device removal was performed in 96 patients (66.2%) and antibiotic therapy was prescribed in 130 (89.7%), with a duration equal to or longer than that recommended in 105 (72.4%) of the patients. Conclusion This study underlines the difficulties in following theoretical guidelines in daily practice, where both technical and human considerations interfere with their strict appliance.

Summary Background Heart failure management guidelines have been published, but the degree of adherence to these guidelines remains unknown. Aims To study in 2015 healthcare utilization and causes of death for people previously identified with heart failure. Methods The national health data system was used to identify adult general scheme (86% of the French population) hospitalized for heart failure between 2011 and 2014 or with only a long-term chronic disease allowance for heart failure. The frequency and median (interquartile range) of at least one healthcare use among those still alive in 2015 was calculated. Results A total of 499,296 adults (1.4% of the population) were included, and 429,853 were alive in 2015; median age 79 (68–86) years. At least one utilization was observed for a general practitioner in 95% of patients (median 8 [interquartile range 5–13] consultations), a cardiologist in 42% (2 [1–3]), a nurse in 78% (16 [4–100]), a loop diuretic in 64% (11 [8–12] dispensations), an aldosterone antagonist in 21% (8 [5–11]), a thiazide in 15% (7 [4–11]), a renin-angiotensin system inhibitor in 68% (11 [8–13]), a beta-blocker in 65% (11 [7–13]), a beta-blocker plus a renin-angiotensin system inhibitor in 57%, and a beta-blocker plus a renin-angiotensin system inhibitor plus an aldosterone antagonist in 37%. Hospitalization for heart failure was present for 8% (1 [1,2]). Higher levels of healthcare utilization were observed in the presence of hospitalization for heart failure before 2015. Among the 13.9% of people who died in 2015, heart failure accounted for 8% of causes, cardiovascular disease accounted for 39%. Conclusions General practitioners and nurses are the main actors in the regular follow-up of patients with heart failure, whereas cardiologist consultations and dispensing of first-line treatments are insufficient with respect to guidelines.

Summary Background The effectiveness of transitional care services for patients discharged from hospital after acute heart failure is challenging, especially in terms of reducing subsequent heart failure hospitalizations. The increased adoption of smartphone applications in society offers a new opportunity to interact with patients to avoid rehospitalization. Thus, electronic health (e-health) can enhance the impact of existing therapeutic education programmes. Aims To determine the prevalence of smartphone use among patients with chronic heart failure, and to assess the epidemiological characteristics and therapeutic management of these patients, with a broader aim of developing smartphone-based therapeutic education programmes for patients. Methods The French Observatoire francais de l’insuffisance cardiaque et du sel (OFICSel) registry was conducted in 2017 by 300 cardiologists, and included both inpatients and outpatients who had been hospitalized for heart failure at least once in the previous 5 years. Data collection included demographic and heart failure-related variables, which were provided by the cardiologist and by the patient via a questionnaire. Results Among the 2822 patients included, 2517 completed the questionnaire. Of this total, 907 patients (36%) were smartphone users. Compared with non-users, smartphone users were younger, were more frequently men, more frequently lived in cities, had a higher educational level and were more frequently professionally active. Smartphone users less frequently had diabetes, hypertension, atrial fibrillation or ischaemic cardiopathy. Only 22% of patients were actively participating in a therapeutic education programme. Conclusion Smartphones were used by more than one-third of patients with heart failure in France in 2017, underscoring the feasibility of developing a smartphone application to deliver therapeutic education to the population with chronic heart failure.

Summary Background Patient education programmes (PEP) are recommended for patients with heart failure but have not been specifically assessed in heart failure with preserved ejection fraction (HFpEF). Aim To assess the effectiveness of a structured PEP in reducing all-cause mortality in patients with HFpEF. Methods Patients with HFpEF were selected from the ODIN cohort, designed to assess PEP effectiveness in patients with HF whatever their ejection fraction, included from 2007 to 2010, and followed up until 2013. Baseline sociodemographic, clinical, biological and therapeutic characteristics were collected. At inclusion, patients were invited to participate in the PEP, which consisted of educational diagnosis, education sessions and final evaluation. Education focused on HF pathophysiology and medication, symptoms of worsening HF, dietary recommendations and management of exercise. Propensity score matching and Cox models were performed. Results Of 849 patients with HFpEF, 572 (67.4%) participated in the PEP and 277 (32.6%) did not. Patients who participated in the PEP were younger (67.0 ± 13.1 vs 76.1 ± 13.2 years; standardized difference [StDiff] = −54.6%), less often women (39.7% vs 48.4%; StDiff = −17.6%) and presented more often with hypercholesterolaemia (55.2% vs 35.2%; StDiff 41.2%), smoking (35.1% vs 28.7%; StDiff 13.8%), alcohol abuse (14.1% vs 8.9%; StDiff 16.5%) and ischaemic HF (38.7% vs 29.2%; StDiff 20.0%) than those who did not; they also presented with better clinical cardiovascular variables. After propensity score matching, baseline characteristics were balanced, except hypertension (postmatch StDiff 19.1%). The PEP was associated with lower all-cause mortality (pooled hazard ratio 0.70, 95% confidence interval 0.49–0.99; P = 0.042). This association remained significant after adjustment for hypertension (adjusted pooled hazard ratio 0.68, 95% confidence interval 0.48–0.97; P = 0.036). Conclusions In this investigation, a structured PEP was associated with lower all-cause mortality. Patient education might be considered an effective treatment in patients with HFpEF.

Summary Background Right ventricular (RV) dysfunction is an important predictor of impaired prognosis in idiopathic dilated cardiomyopathy. Aims To determine the prognostic role of RV dysfunction, independent of left ventricular (LV) dysfunction. Methods A total of 136 consecutive patients (73% men; mean age 59.0 ± 13.2 years) with idiopathic dilated cardiomyopathy (LV ejection fraction ≤ 45%) were enrolled retrospectively. Thirty-four patients (25%, group 1) presented with RV dysfunction, defined as tricuspid annular plane systolic excursion (TAPSE) ≤ 15 mm; 102 patients (group 2) had preserved RV function. Results Mean LV ejection fraction was 27.5 ± 8.7%. Mean TAPSE was 18.6 ± 5.4 mm (15–21.8 mm). Multivariable predictors of RV dysfunction were LV outflow tract time-velocity integral (odds ratio 0.8, 95% confidence interval [CI] 0.7–0.9; P = 0.003) and E-wave deceleration time ≤ 145 ms (odds ratio 4.1, 95% CI 1.3–12.8; P = 0.017). Major adverse cardiac event-free survival rates at 1 and 2 years were 64% and 55%, respectively, in group 1 and 87% and 79%, respectively, in group 2 ( P = 0.002). Both by multivariable analysis and after stratification using a propensity score, RV dysfunction emerged as an independent predictor for major adverse cardiac events (hazard ratio 3.2, 95% CI 1.3–7.6; P = 0.009), along with right atrium area and age. Conclusion In idiopathic dilated cardiomyopathy, RV dysfunction with TAPSE ≤ 15 mm offers additional prognostic information, independent of the extent of LV dysfunction.

SummaryBackgroundChronic heart failure (CHF) is a frequent severe disease. Disease-management programmes, which contain a therapeutic patient education component, will play a central role in improving delivery of care and reducing mortality and hospitalizations for CHF.AimsIn order to have an up-to-date overview of medical treatment of CHF in France implemented by hospital and clinic cardiologists especially interested in CHF and therapeutic patient education, we described the prescription of cardiovascular drugs in the large ODIN cohort of CHF patients, according to age and type of CHF.MethodsFrom 2007 to 2010 (median follow-up 27.2 months), CHF patients were prospectively enrolled in a multicentre ‘real-world’ French cohort by centres previously trained in therapeutic patient education. Patients were grouped according to age (

Summary Background Cardiovascular diseases (CVDs) constitute the second leading cause of death in France. The Systeme national d’information interregimes de l’assurance maladi e (SNIIRAM; national health insurance information system) can be used to estimate the national medical and economic burden of CVDs. Objectives To describe the rates, characteristics and expenditure of people reimbursed for CVDs in 2013. Methods Among 57 million general health scheme beneficiaries (86% of the French population), people managed for CVDs were identified using algorithms based on hospital diagnoses either during the current year (acute phase) or over the previous 5 years (chronic phase) and long-term diseases. The reimbursed costs attributable to CVDs were estimated. Results A total of 3.5 million people (mean age, 71 years; 42% women) were reimbursed by the general health scheme for CVDs (standardized rate, 6.5%; coronary heart disease, 2.7%; arrhythmias/conduction disorders, 2.1%; stroke, 1.1%; heart failure, 1.1%). These frequencies increased with age and social deprivation, and were higher in Northern and Eastern France and Reunion Island. The total sum reimbursed by all schemes for CVDs was € 15.1 billion (50% for hospital care and 43% for outpatient care [including 15% for drugs and 12% for nurses/physiotherapists]); coronary heart disease accounted for € 4 billion, stroke for € 3.5 billion and heart failure for € 2.5 billion (i.e. 10% of the total expenditure reimbursed by all national health insurance schemes for all conditions). Conclusion CVDs constitute the leading group in terms of numbers of patients reimbursed and total reimbursed expenditure, despite a probable underestimation of both numbers and expenditure.

SummaryBackgroundHeart failure is the leading cause of hospital admissions and an economic burden. In accordance with European guidelines, a dedicated heart failure unit was created in René Dubos Hospital (Pontoise, France) in 2002.AimTo evaluate the impact of an in-hospital heart failure management unit on heart failure prognosis.MethodsWe conducted a descriptive study of all-cause in-hospital mortality and heart failure related readmission rates in the year after the first admission for heart failure, from January 1997 to December 2007. The Chi2 test, a trend test and linear regression were performed.ResultsThere were no significant differences in patient characteristics (age, sex, diabetes mellitus, left ventricular ejection fraction

Summary Background Education programmes are required in chronic diseases. The insuffisance cardiaque : education therapeutique (I-CARE) programme was developed in France to promote the setting-up of therapeutic education units for chronic heart failure. Aim To evaluate the setting-up of such units, assessing the influence of training on the creation and organization of the unit, the problems encountered and the contribution of the dedicated educational tools. Methods We submitted a questionnaire to the first 136 trained centres. The questionnaire was divided into two sections: one section dealing with educational practices and the other with the advantages and disadvantages of the tools provided. Results The participation rate reached 69.1%. Seventy-four centres (78.7%) declared themselves to be active in therapeutic education. Unit educational activities determined an educational diagnosis (89.2% of the centres) and provided education by means of collective workshops (73.0%) or one-to-one teaching sessions (75.7%). A complete education programme for a patient consisted of a median of four sessions (25th–75th percentile, 2–5 sessions) and lasted for a median of 6 h (25th–75th percentile, 4–10 h). The education team was multidisciplinary and usually included a nurse (93.2%), a dietician (78.4%), a cardiologist (71.6%) and a physiotherapist (40.5%). Heart failure educational tools were used only in part in most centres (89.2%). All advantages and disadvantages were recorded. Conclusion This first evaluation of the setting-up of therapeutic education units in the I-CARE programme has yielded promising results, despite expected difficulties. The effects of therapeutic education on the behaviour of heart failure patients remain to be determined.

Summary Background Whereas the coronary artery disease death rate has declined in high-income countries, the incidence of acute coronary syndromes (ACS) is increasing in sub-Saharan Africa, where their management remains a challenge. Aim To propose a consensus statement to optimize management of ACS in sub-Saharan Africa on the basis of realistic considerations. Methods The AFRICARDIO-2 conference (Yamoussoukro, May 2015) reviewed the ongoing features of ACS in 10 sub-Saharan countries (Benin, Burkina-Faso, Congo-Brazzaville, Guinea, Ivory Coast, Mali, Mauritania, Niger, Senegal, Togo), and analysed whether improvements in strategies and policies may be expected using readily available healthcare facilities. Results The outcome of patients with ACS is affected by clearly identified factors, including: delay to reaching first medical contact, achieving effective hospital transportation, increased time from symptom onset to reperfusion therapy, limited primary emergency facilities (especially in rural areas) and emergency medical service (EMS) prehospital management, and hence limited numbers of patients eligible for myocardial reperfusion (thrombolytic therapy and/or percutaneous coronary intervention [PCI]). With only five catheterization laboratories in the 10 participating countries, PCI rates are very low. However, in recent years, catheterization laboratories have been built in referral cardiology departments in large African towns (Abidjan and Dakar). Improvements in patient care and outcomes should target limited but selected objectives: increasing awareness and recognition of ACS symptoms; education of rural-based healthcare professionals; and developing and managing a network between first-line healthcare facilities in rural areas or small cities, emergency rooms in larger towns, the EMS, hospital-based cardiology departments and catheterization laboratories. Conclusion Faced with the increasing prevalence of ACS in sub-Saharan Africa, healthcare policies should be developed to overcome the multiple shortcomings blunting optimal management. European and/or North American management guidelines should be adapted to African specificities. Our consensus statement aims to optimize patient management on the basis of realistic considerations, given the healthcare facilities, organizations and few cardiology teams that are available.

International audience; BACKGROUND:Care provider support for therapeutic patient education (TPE), its results and relationships with patients are factors in the setting up and sustainability of this practice.AIM:With a view to understanding the factors determining TPE care provider participation and favouring its development, the aim of this study was to describe the perception healthcare providers have of TPE in heart failure.METHODS:A national survey by self-administered questionnaire was performed in 2013 in 61 Observatoire de l'INsuffisance cardiaque (ODIN; Heart Failure Observatory) centres participating in the I-CARE programme. The cardiologist in charge of each centre received five questionnaires: one for him/herself and four for other healthcare providers working with him/her.RESULTS:We received 116 responses out of the 305 questionnaires sent (38.0%). Almost all of the responders stated that the patients were more observant after TPE sessions (91.4%). According to the responders, patients were better informed thanks to TPE (53.9%); they stated that TPE had changed their relationships with patients (81.9%); they also felt that they were educating the patient's close family/friends at the same time as the patients (86.2%).CONCLUSION:The survey showed that TPE improves care relationships. Healthcare providers recognize that they have been working differently since the programme was set up, and want the patient's close family/friends to be involved in treatment.

SummaryCardiovascular mortality has decreased over the past 25 years, largely because of acute coronary syndrome care and preventive actions. Nevertheless, the rate of coronary heart disease remains high, with an annual risk of 4.7% (cardiac mortality, myocardial infarction, stroke). Cardiovascular risk factor management must be a priority in primary and secondary prevention, to improve the prognosis of this severe disease, in which absence of symptoms does not mean benignity. The current goals of therapeutic patient education are smoking cessation, regular physical activity, a cardioprotective (Mediterranean) diet, management of stress, good treatment adherence (which improves compliance), judicious use of the care system and help with occupational reintegration. Current and future programmes must be in accordance with the Haute Autorité de Santé recommendations published in 2007.

SummaryBackgroundNational population-based management and outcome data for patients of all ages hospitalized for heart failure have rarely been reported.AimNational population-based management and outcome of patients of all ages hospitalized for heart failure have rarely been reported. The present study reports these results, based on 77% of the French population, for patients hospitalized for the first time for heart failure in 2009.MethodsThe study population comprised French national health insurance general scheme beneficiaries hospitalized in 2009 with a principal diagnosis of heart failure, after exclusion of those hospitalized for heart failure between 2006 and 2008 or with a chronic disease status for heart failure. Data were collected from the national health insurance information system (SNIIRAM).ResultsA total of 69,958 patients (mean age, 78 years; 48% men) were studied. The hospital mortality rate was 6.4%, with 1-month, 1-year and 2-year survival rates of 89%, 71% and 60%, respectively. Heart failure and all-cause readmission-free rates were 55% and 43% at 1 year and 27% and 17% at 2 years, respectively. Compared with a reference sample of 600,000 subjects, the age- and sex-standardized relative risk of death was 29 (95% confidence interval [CI] 28–29) at 2 years, 82 (95% CI 72–94) in subjects aged

Digoxin therapy is used to treat heart failure patients for more than 200 years. However, absence of effect on overall mortality found in the DIG study associated with frequent adverse effects due to overdosing in elderly patients with impaired renal function finally persuaded medical opinion to the weak interest of digoxin in chronic heart failure. Its image of old-fashioned drug in the mind of young cardiology generations appears widely distorted, and suffers from the absence of promotion by pharmaceutical industry, given a very low cost and a rapid arrival onto the generic market. Yet, regarding strict data from the literature, it remains a lot of positive factors in favor of the interest for digoxin: reduction of morbidity, reduction of mortality at low serum concentration

SummaryThe importance of right ventricular (RV) function in the clinical management of patients with cardiopulmonary disorders is now well recognized. However, due to both its shape and location and to the load dependence of its ejection fraction, accurate evaluation of its function is still a challenge. Echocardiography allows morphological, hemodynamic and functional assessment of the right heart. Displacement and deformation parameters derived from new techniques are promising tools. 3D echocardiography also has a potential interest in the quantification of RV volumes and ejection fraction. Radionuclide technique allows an easy and accurate measurement of right ventricular ejection fraction. MRI remains nowadays the technique of choice for the quantification of volumes and function of the RV. All these techniques have proven their interest in various diseases affecting the right heart. RV function is an important prognostic factor in heart failure and is a major component of functional capacity in such patients. In pulmonary arterial hypertension, echocardiography is the best tool for the routine follow-up of patients. Finally, all these non-invasive techniques of investigation of the right heart enable the diagnosis of specific right ventricular damage such as myocardial infarction or arrhythmogenic right ventricular dysplasia.

Summary Background In Europe, the increase in numbers of patients making legal claims might be due to better knowledge of their rights. In France, a law passed in 2002 provided new opportunities for claims. Aim To assess patient claims related to care in a French cardiology department. Methods From 2003 to 2007, claims brought before the courts and actions of conciliation within the scope of the hospital were collected by year. Cardiology department claims were individualized and compared with those for other departments. Characteristics of patients at the time of the care that prompted the claim, percentage of deaths, reasons for claims and claim results were collected. Results During the 4-year study period, 14% ( n = 45,272) of hospital admissions concerned cardiology, uniformly distributed across the years. In the same period, 845 procedures were recorded, 81 of which related to cardiology. The complaints index was 2.59/1000 patients for the general population and 1.79/1000 for cardiology. The 81 cardiology complaints (52 mediations; 29 litigations) concerned patients aged 62 ± 13 years (68% men). The number of cardiology claims remained stable from 2003 to 2007. Compared with claims concerning other departments, the nature of the plaintiff (more often heirs or husband/wife) and the reason for the claim (less frequently medical care problems; more often death and nosocomial infections) were statistically different. Conclusion Claims related to cardiology care were low and relatively stable over the past 4 years. Nosocomial infections prompted a high proportion of claims and should lead physicians to be vigilant. Cardiology remains relatively protected from litigation. A national registry of hospital claims might be valuable.

Background Few studies have analyzed the cost of treatment of chronic angina pectoris, especially in European countries. Aim To determine, using a modeling approach, the cost of care in 2012 for 1 year of treatment of patients with stable angina, according to four therapeutic options: optimal medical therapy (OMT); percutaneous coronary intervention with bare-metal stent (PCI-BMS); PCI with drug-eluting stent (PCI-DES); and coronary artery bypass graft (CABG). Methods Six different clinical scenarios that could occur over 1 year were defined: clinical success; recurrence of symptoms without hospitalization; myocardial infarction (MI); subsequent revascularization; death from non-cardiac cause; and cardiac death. The probability of a patient being in one of the six clinical scenarios, according to the therapeutic options used, was determined from a literature search. A direct medical cost for each of the therapeutic options was calculated from the perspective of French statutory health insurance. Results The annual costs per patient for each strategy, according to their efficacy results, were, in our models, € 1567 with OMT, € 5908 with PCI-BMS, € 6623 with PCI-DES and € 16,612 with CABG. These costs were significantly different (P

Contexte L’homocysteine est un facteur de risque des maladies cardiovasculaires. Les perturbations des activites du cycle de remethylation de l’homocysteine, liees a une carence de groupements methyles, seraient probablement impliquees dans la pathogenese de ces maladies. Objectif Etudier les repercutions du regime carence en donneurs de methyles sur le myocarde des ratons nes de meres carencees, et determiner les effets sur les activites enzymatiques du cycle de l’homocysteine, et sur le metabolisme lipidique. Methodes Modele : Rats Wistar alimentes avec un regime carence un mois avant la mise en accouplement et poursuivi jusqu’au sevrage. Analyses Biochimiques : Dosages vitaminiques, activites enzymatiques, metabolites du cycle de l’homocysteine, concentration en carnitine, BNP et recepteurs d’adenosine. Voies de signalisation. Proteines AKT/PKB (hypertrophie) Analyses Fonctionnelles. Fraction d’ejection (FEVG) par miniPET et mesure de la pression arterielle. Resultats La carence maternelle diminue les concentrations plasmatiques en vitamines B9 et B12 et une hyperhomocysteinemie. On observe une augmentation des taux de SAM et de SAH ainsi que de l’activite MS. Histologie : Hypertrophie myocardique. Augmentation significative du taux de BNP plasmatique en absence d’une dysfonction systolique chez le rat carence. Parallelement il y a une augmentation du recepteur A2A. Il existe un effet ambivalent de l’hyperhomocysteinemie sur les acylcarnitines avec une augmentation au niveau plasmatique et une diminution au niveau tissulaire chez le rat carence. La carence n’induit pas de modification de l’expression des certaines proteines impliquees dans le voies AKT/PKB. Conclusion Chez le raton carence les modifications du BNP temoignent d’un stress de la paroi myocardique. Puisque les acides gras sont la principale source d’energie du myocarde, un deficit en acylcarnitine suggere un probleme de production d’energie qui pourrait expliquer l’hypertrophie par un mecanisme adaptatif.