[Show abstract][Hide abstract] ABSTRACT: Heart 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.
To evaluate the impact of an in-hospital heart failure management unit on heart failure prognosis.
We 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 Chi(2) test, a trend test and linear regression were performed.
There were no significant differences in patient characteristics (age, sex, diabetes mellitus, left ventricular ejection fraction<45%) other than renal insufficiency, in patients admitted for heart failure from 1997 to 2007. After the creation of the heart failure unit, we observed a significant decrease in heart failure related readmission rate from 21.7% in 2002 to 15.6% in 2007 (p<0.0001), whereas there was no difference in this rate before the creation of the unit (34.3% in 1997 and in 2001; p=0.90). All-cause in-hospital mortality rate decreased from 9.3% in 1997 to 5.1% in 2007 (p<0.0001) and showed a tendency to decrease after the creation of the heart failure unit (p=0.06).
Heart failure related readmission rates in new patients in the year after the first admission for heart failure reduced dramatically after the creation of the heart failure unit. All-cause in-hospital mortality in heart failure patients decreased over the 10-year study period.
Full-text · Article · Feb 2010 · Archives of cardiovascular diseases
[Show abstract][Hide abstract] ABSTRACT: Background
Heart Failure (HF) is a frequent and severe disease. Overall prognosis of systolic HF is poor, and one-year survival rate is lower than most cancers. For that reason, HF units were progressively created in cardiology departments according to the European guidelines.
The aim of this study was to describe the evolution in all-cause in-hospital mortality in patients hospitalized for HF in the HF clinic created at René Dubos hospital (Pontoise, France).
We conducted a descriptive study of all-cause in-hospital mortality in a whole population of 4801 patients hospitalized for HF (range per year: 248-640 patients) from January 1997 to December 2007 in our HF clinic. Chi square, test for trend and linear regression were performed.
Our population consisted of 2331 men (48.6%) with a mean age per year ranging from 67.8 to 75.8 years, and a percentage of patients presenting with systolic HF (LVEF<45%) of 53.8%. There were no significant differences in terms of sex, diabetes mellitus or LVEF<45%, except for age and renal insufficiency. All-cause in-hospital mortality rate for patients hospitalized for HF appeared to be significantly decreasing during ten-year follow-up (p<0.0001) (see figure). Moreover we noticed that average length of hospital stay was decreasing during ten-year follow-up (p=0.027, -0.3 day per year).
Mortality in HF patients was confirmed to be decreasing during the last ten-year period, thereby confirming the impact of HF care management on HF prognosis.
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Full-text · Article · Jan 2010 · Archives of Cardiovascular Diseases Supplements
[Show abstract][Hide abstract] ABSTRACT: Subject: The objective is to analyze in which way agents appropriate for themselves managerial tools and what effect this can have on the organization. Method: DRG-Evaluation in terms of managerial and medical criteria at the Pontoise hospital on the basis of data coming from the DRG-System (PMSI) and the National Cost study (ENC). Regular discussions took place between the medical controller, the financial controller and the cardiologist. Results: The integration of organizational elements such as the patients' education and a pluri-disciplinary team make it possible to optimize the health care structure while reducing costs at the same time. On the basis of a managerial and medical follow-up other organizational leverages are identified: a better orientation of patients in the emergency department and a closer collaboration with other departments. Conclusion: A key figure becomes a tool once it has been appropriated by the agents for themselves and once it serves the agents in their activity. In this example different functions of the tool have been observed: they allow us to identify differences between entities and tendencies. In particular they constitute a basis to rethink and redesign the organization.