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Background Outcome of acute heart failure (AHF) patients according to the final destination after emergency department (ED) has been poorly studied with contradictory results. Purpose To compare long-term outcomes after an episode of acute heart failure (AHF) in patients according to their destinations after ED. Methods OFICA (Observatoire Francais de l’Insuffisance Cardiaque Aigue) is a French snapshot registry of all patients with ongoing hospitalization for AHF in a nationwide and representative sample of 170 French hospitals. One thousand six hundreds and fifty-seven patients were included the 12th of March, 2009. Various data were collected including the final destination after ED and patients were followed-up for death as primary outcome. Hazard ratios were calculated for patients admitted in geriatric departments and other wards then compared with those hospitalized in cardiology. P Results Mean age was 76,0 ± 13,2 y with a sex-ratio close to 1. Overall, the small number of AHF patients referred from the ED to a cardiology ward was 19% with more frequently HF REF. Besides, AHF patients admitted in geriatric unit were older (p Conclusion While patients have similar 1-year outcomes irrespective of the destination after ED care for an AHF episode, those initially admitted in geriatrics present worse 5-year outcomes when managed by non-cardiology departments, despite adjustment for different clinical patient profiles. Reasons for this heterogeneous specialty-related performance should be investigated.

BackgroundHeart failure (HF) symptoms, related to pulmonary capillary hypertension, are frequent in hypertrophic cardiomyopathy (HCM). Pulmonary hypertension (PH) is the consequence of left ventricular (LV) diastolic pressure elevation and/or functional mitral regurgitation. We aimed to evaluate determinants and prognostic significance of rest and exercise PH in HCM.Methods and ResultsWe included 235 patients referred for clinical work-up of HCM. Rest pulmonary artery systolic pressure (PASP) was measurable in 214 (91%) patients (48±16 years, 161 males). A symptom-limited semi-supine bicycle exercise was carried out in 188 patients. PASP was measurable during exercise in 108 patients (57%). Resting PH (≥36mm Hg) was present in 56 patients (26.2%) and exercise PH (≥60mm Hg) in 38 patients (35.2%). Mutivariate correlates of rest PASP were sinus rhythm (β= –0.15, P=0.021), LV obstruction tract (LVOT) peak gradient (β= 0.22, P=0.001) and left atrial volume (β= 0.39, P

We report on a family with a rare form of cardiac and non-cardiac disease that shed new lights on the clinical spectrum associated with desomomal gene mutations, usually related to arrhythmogenic right ventricular cardiomyopathy. The 29-year-old patient presented with woolly hair from infancy and palmoplantar keratoderma, leuconychia (hands and feet) and oligodontia (agenesis of 4 teeth). Global cardiac biventricular involvement was present on echocardiography and MRI. Late potentials were present on signal-average ECG and ventricular premature beats (PVB) on Holter-ECG (>10/24h). A single-chamber prophylactic implantable cardioverter-defibrillator was implanted. The son of the patient had palmoplantar keratoderma, woolly hair, oligodontia (agenesis of 10 teeth) and brittle nails. At 10 years of age, a diagnosis of acute myocarditis was made (chest pain, cardiac troponin elevation, multiple isolated PVB, typical sign on MRI). RV infundibulum was dilated on Echocardiography. Evolution was unremarkable after medical treatment. A heterozygous missense mutation (c.1691C>T, p. Thr564Ile) was identified in the desmoplakin gene (both in father and son). No additional mutation was identified in other desomosomal genes. Carvajal/Naxos syndromes are usually recessive and characterized by wooly hair, palmoplantar keratoderma and a cardiomyopathy. We report on a family with unique features associated with a new mutation of desmoplakin gene. First, mode of inheritance is autosomal dominant and not recessive. Second, clinical expression is associating not only the usual Carvajal/Naxos syndrome but also oligodentia and leuconychia. This report (i) extends the phenotype associated with desmosomal gene mutations, (ii) demonstrates that leuconychia and oligodentia may be associated with severe cardiomyopathy and may therefore require systematic cardiac examination, (iii) suggests that desmoplakin gene is involved in the normal and abnormal development of teeth and nails.

BackgroundHeart failure (HF) symptoms, related to pulmonary capillary hypertension, are frequent in hypertrophic cardiomyopathy (HCM). Pulmonary hypertension (PH) is the consequence of left ventricular (LV) diastolic pressure elevation and/or functional mitral regurgitation. We aimed to evaluate determinants and prognostic significance of rest and exercise in HCM.Methods and resultsWe included 235 patients referred for clinical work-up of HCM. Rest pulmonary artery systolic pressure (PASP) was measurable in 214 (91%) patients (48±16 years, 161 males). A symptom-limited semi-supine bicycle exercise was carried out in 188 patients. PASP was measurable during exercise in 108 patients (57%). Resting PH (≥36mmHg) was present in 56 patients (26.2%) and exercise PH (≥60mmHg) in 38 patients (35.2%). Mutivariate correlates of rest PASP were sinus rhythm (β=–0.15, P=0.021), LV obstruction tract (LVOT) peak gradient (β=0.22, P=0.001) and left atrial volume (β=0.39, P

Background The prevalence of anaemia in chronic heart failure (CHF) ranges widely from 4 to 70% due to a lack of an established consistent definition of anaemia in CHF. Furthermore haemodilution impacts haemoglobin concentrations and could be an important cause of anaemia in CHF. Aims The IMPACT-RECO program III analysed the impact of NYHA class of CHF and of comorbidities on therapeutic management of French outpatients with stable CHF and left ventricular systolic dysfunction. Methods This survey was carried out from March 2007 to December 2007 among randomly selected French private cardiologists. 1574 patients with CHF and left ventricular ejection fraction (LVEF) Results Mean age was 71 ± 11 years, 75% of the patients were men, 34% were in NYHA class III-IV, 54% had coronary artery diseases, 30% had atrial fibrillation and the mean LVEF was 34 ± 7%. Haemoglobin concentration was recorded in 953 patients. Anemia was defined as a haemoglobin concentration Conclusions Congestive status impacts haemoglobin concentrations more than the severity of CHF estimated by NYHA class. Haemodilution is an important aetiology of anaemia in CHF, thus haemoglobin concentration should be evaluated if possible in patients without congestive signs. Haemoglobin (g/L) NYHA I NYHA II without congestive signs NYHA II with congestive signs NYHA III NYHA IV n 107 448 62 295 37 Men 13.3 ± 1.6 13.4 ± 1.7 12.1 ± 1.9 12.7 ± 1.8 13.4 ± 1.6 Women 12.7 ± 1.2 12.6 ± 1.3 11.8 ± 2.5 12.1 ± 1.6 12.2 ± 2.1 Anaemia N (%) 33 (30.8) 150 (33.5) 42 (67.7) ** 149 (50.5) * 15 (40.5) * p ** p

BackgroundThe recent European Guidelines for the treatment of CHF 2008 underlined that the majority of patient with CHF and COPD can safely tolerate β-blocker therapy.AimsThe IMPACT-RECO program III analysed the impact of NYHA class and of comorbidities on therapeutic management of French outpatients with stable CHF and left ventricular ejection fraction (LVEF) < 40%.MethodsThis survey was carried out from March 2007 to December 2007 among randomly selected French private cardiologists. 1574 patients with CHF and LVEF < 40% were included. Key demographics including comorbidities such as asthma and COPD, as well as ongoing medical treatment of CHF were collected. Physicians were asked about reasons for not prescribing β-blockers.ResultsMean age was 71±11 years, 75% of the patients were men, 34% were in NYHA class III-IV, 54% had coronary artery disease, 30% atrial fibrillation and the mean LVEF was 34±7%. 78.3% of the patients received a β-blocker, and asthma or BPCO were reported in 13.7%. 341 patients were not receiving β-blockers. The first reason for non-prescription was presumed contra-indication in 51.9% (177 pts). This contra-indication was asthma or COPD in 71%, symptomatic hypotension in 15%, bradycardia in 12% and other problems in 8%. The second reason for non prescribing β-blockers was previous side effects in 35.2% (120 pts) including heart failure decompensation in 39%, symptomatic hypotension in 36%, asthenia in 26%, bradycardia in 18%, impotence in 5% and others in 6%. Lastly, in 10.9% of patients without β-blockers, the reason for non prescription was fear of potential side effect.ConclusionRespiratory disease remains the main reason for not prescribing β-blockers in CHF despite the fact that selective β-blockers are now recommended in this population. Room remains for improvement in β-blockers prescription rate in CHF patients with concomitant COPD, underscoring the importance of pursuing education of cardiologists.

Background Few data are available about real life and management of patients heart failure with preserved systolic function (HF-PSF). Objective To describe patients, disease characteristics and treatment strategies implemented in HF-PSF patients hospitalized for confirmed acute HF with LVEF≥45%. Methods An observational study was conducted in 68 hospital in France with 2 steps: (1) a registry part in patients hospitalized for confirmed acute HF for estimation of proportion of HF-PSF patients in the overall HF patients. (2) a detailed part with data collection of patients recently diagnosed for HF-PSF (LVEF ≥ 45% evaluated within 8 days following hospitalization date). Results 707 HF patients were enrolled in the registry with a proportion of 51% with HF-PSF. In detailed part 364 HF-PSF patients were selected, with a mean age of 79 years, 59%female, and a mean BMI 27.7kg/m. Main cardiovascular characteristics of HF-PSF patients were: atrial fibrillation (51%), coronary heart disease (32%), peripheral arterial disease (15%) and stroke (13%) as CV antecedents and hypertension (78%), obesity (45.5%) and diabetes (29%) as risk factors. Mean values were: blood pressure 133/86mmHg, HR 92beats/min, creatinine 13.8mg/l, haemoglobin 12.0g/dl. BNP was performed in 243 patients with a median value of 684 pg/ml and Nt-pro-BNP in 77 patients with a median value of 3999 pg/ml. Mean ejection fraction was 58±8%. Non CV co-morbidities were: renal failure(39%), COPD(20%), walking disorders (22%), depression(12%),cognitive disorders(8%)and cancers(5%). Treatment at discharge included: diur. (85%), ACE-i(57%), βB (56%), Ca antag (27%), ARB (20%), aldosterone blockers (13%), digoxin (16%), anticoagulants (52%), statins (48%), aspirin (32%) and amiodarone (28.5%). Conclusion Much is not known about the epidemiology and management of HF-FSP in France but our study try to improve the knowledge on this disease with real life data even if until today there is no specific treatment.

BackgroundSome studies have suggested a high frequency of cognitive disorders in HF patients.ObjectiveTo determine the prevalence of cognitive disorders in chronic HF elderly patients.MethodsWe assessed in an observational study the cognitive function in consecutive HF outpatients followed by French cardiologists. Patients were included if they were aged ≥70 years, had chronic stable HF and have been hospitalized for HF in the last 12 months. Cognitive function was assessed by the largely used MIS (Memory Impairment Screen). Autonomy was assessed by IADL scale (Instrumental Activities of Daily Living).ResultsA total of 980 patients were enrolled by 291 cardiologists. Mean age was 79 ± 6 years and 66% were men. Feasibility of MIS was high and the test was performed successfully in 94% of patients by cardiologists. Cognitive disorders were observed in 46% of HF patients. Loss of autonomy was observed in 47% of elderly HF subjects and help by nurses at home was needed in 33% of patients.Patients with cognitive disorders were older (81 years vs 78 years, p

Background Recent registries have shown that recommended drugs for the treatment of congestive heart failure (CHF) remain under-prescribed in daily practice. Aims To compare prescription rates of CHF drugs in three French surveys Impact Reco I, II and III. Methods We included outpatients followed by private cardiologists: 1947 in Impact Reco I (2005), 1974 in Impact Reco II (2005/2006) and 1574 in Impact Reco III (2007), with NYHA class II-IV heart failure and a left ventricular ejection fraction Results There was an improvement in both the rate of prescription, and in the proportion of patients reaching target dose or 50% of target dose of ACE I, ARBs and beta blockers (see table). Conclusion We observed an improvement with time in the management of CHF outpatients with an increase in prescription rates of recommended CHF drugs, as well as in the dosage used for ACE-I, ARB and beta-blockers, Prescription IMPACT I 2005 IMPACT II 2005/2006 IMPACT III 2007 Global population 1917 1974 1574 ACE I Number patients with prescription N (%) 1361 (71.0) 1349 (68.3) 1099 (70.2) Target dose % 48.7 57.3 * 52.3 • 50% Target dose % 80.4 84.5 * 88.4 † , • ARBs Number patients with prescription N (%) 395 (20.6) 592 (30.0) * 516 (33.3) † , • Target dose % 9.1 7.4 20.7 † , • 50% Target dose % 52.9 49.7 68.6 † , • Betablockers Number patients with prescription N (%) 1245 (65.2) 1382 (70.0) * 1229 (78.3) † , • Target dose % 18.4 23.4 * 25.7 † 50% Target dose % 47.3 53.5 * 59.9 †• * : p • : p † : p although there is still room for improvement particularly for beta blockers. These encouraging findings suggest a better awareness and implementation of ESC guidelines by French private cardiologists.