Description des pratiques du médecin généraliste dans l’optimisation du traitement de l’insuffisance cardiaque chronique en sortie d’hospitalisation : état des lieux et perspectives

摘要

Introduction: Heart failure (HF) is a common and serious disease, with constantly increasing incidence. The HAS emphasizes general practitioner’s role in chronic HF patients management. The aim was to describe their practice in optimizing systolic HF treatment after hospital discharge. Method: Patients hospitalized for systolic HF in Nanterre’s hospital cardiology department and having a general practitioner were enrolled from February 2014 to January 2015. Demographic, clinical, biological, ultrasound data and treatments were collected. A questionnaire was submitted to general practitioners two months after discharge. Results: Eighty-two patients were included. The target dose of ACE inhibitors and betablockers were achieved for 18% of patients (n=15) during hospitalization. Forty-two doctors participated. We obtained answers for 60% of patients (n=49). None of the doctors modified ACE inhibitors and betablockers doses during follow-up. The reasons were lack ofpatient consultation (60%, n=25), good tolerance (44%, n=18), lack of habits with these treatments (22%, n=9) and relying on the cardiologist (51%, n=17). Practitioners expressed difficulty in modifying betablockers (59%, n=24). Improvements are approved by physicians: more precise hospitalization report, alternating consultations, education sessions. Conclusion: Patients with HF are under-treated and general practitioners do not optimize the treatment after hospital discharge. This underlines the difficulty to apply the guidelines. Some changes are proposed in order to improve patients’ care and to strengthen collaboration between hospital doctors and general practitioners.