Impact pronostic d’une consultation précoce du médecin traitant dans les suites d’une hospitalisation pour une poussée d’insuffisance cardiaque : analyse de l’influence des facteurs médicaux, sociaux et culturels

摘要

Background: Heart failure is a severe condition whose incidence is increasing. The HAS has recently recommanded an early consultation at the general practitioner, after an hospitalization for acute heart failure. Aim : We assessed the clinical impact of an early consultation at the GP after being hospitalized for heart failure. Methods : All the patients admitted for acute heart failure at the hospital of Montreuil in the first half of 2013 were prospectively followed for a six months period. The main data collected was the occurrence of a visit at the doctor’s during the first 6 weeks after discharge, and serious clinical events (new outbreaks and / or new emergency admission); these have been analysed from informations obtained by interviewing patients and their physician on the phone. Results : During the survey 138 patients were enrolled from January to June 2013. Of these, 111 (80.4%) had visited their doctor within 6 weeks of discharge. Early consultation was correlated with the occurrence of serious events without being statistically significant (19,82 ± 3,8 in patients who viewed against 33,3 ± 9,2, p=0,13). Risk factors for non consultation were the age (81,7 years in patients who did not consult vs 76,7 among those who did, p=0,04), having no children (58% of those who did not visit had children vs 88% of those who visited, p=0,0002), being born abroad (38,2% vs 16,2%, p=0,01) and isolation at home (52,6% vs 32,7%, p=0,09). Conclusion : The lack of early consultation with the doctor after an hospitalization for heart failure onset is correlated to the occurrence of severe clinical events at 6 months. Identifying risk factors influencing this consultation should enable enhanced monitoring and improving the prognosis.