107 Care management of heart failure in elderly patients in France. Results from the DEVENIR study

RationaleThe part of elderly patients (pts) in heart failure (HF) population is growing. They might pose specific problems due to the greater proportion of HF with preserved LVEF, more frequent comorbidities or contra-indications to recommended HF treatment.Objectivesto describe the care management of pts > 80-year treated for HF in France.MethodsCross sectional observational survey with retrospective collection of data at hospital discharge. Pts must have been diagnosed with CHF and have been hospitalised for CHF within the previous 18 months. Pts are classified according to the LVEF at hospital discharge.Results412 French outhospital cardiologists entered 1 452 pts meeting the inclusion criteria. FEVG at hospital discharge was known for 1408 pts. 355 (25%) were more than 80-year-old. Management care at hospital discharge according to age and LVEF is detailed below.LVEF < 40%LVEF 40-50%LVEF > 50%TotalAge>80ACEI/ARB84%81%80%82%*BB71%67%40%†,‡62%*Loop diuretics92%85%85%88%Spironolactone/eplerenone26%20%18%22%*Digoxin20%15%29%21%*Calcium antagonists10%14%37%†,‡18%Anticoagulants49%45%51%49%*Age≤80ACEI/ARB93%93%85%†,‡92%BB79%78%76%79%Loop diuretics90%82%79%†,§86%Spironolactone/eplerenone35%21%25%†,§30%Digoxin16%15%16%15%Calcium antagonists9%19%21%†,§13%Anticoagulants42%39%39%41%†p<0.05 for comparisons between LVEF > 50% and LVEF<40%;‡p<0.05 for comparisons between LVEF>50% and LVEF between 40% and 50%;§: p<0.05 for comparisons between LVEF<40% and LVEF between 40% and 50%;*p<0.05 for comparisons between > 80 and ≤ 80 years old adjusted for LVEF.ConclusionBB, ACEI/ARB, spironolactone/eplerenone are less often prescribed in elderly patients contrasting with digoxin and anticoagulants prescription. These differences persist after adjustment on LVEF

088 Prescription of beta blockers at hospital discharge and beyond, in patients with heart failure. Results from the DEVENIR study

RationaleBeta blockers are a corner stone treatment of heart failure (HF) in patients with altered systolic function (LVEF<40%). Guidelines are less clear for HF patients with preserved systolic function (LVEF>50%) or for patients belonging to the “grey zone” (LVEF 40-50%).Objectivesto describe the prescription rate of beta-blockers in HF patients.MethodsCross sectional observational survey with retrospective collection of data at hospital discharge. Patients must have been diagnosed with CHF and have been hospitalised for CHF within the previous 18 months. Patients are classified according to the LVEF at hospital discharge.Results1 452 patients were included by 412 French outhospital cardiologists. 1137 with known LVEF at hospital discharge have had at least one visit by the cardiologist between hospital discharge (mean delay 5.76±4.51 months). In a multivariate model, BB prescription was more frequent in HF from ischemic origin (OR=1.39) or with dilated cardiomyopathy (OR=1.44) and less frequent in older patients (OR=0.97 per year) and in case of asthma/COPD (OR=0.31 and if FEVG was >50% (OR=0.62).LVEF < 40% N=661LVEF 40-50% N=282LVEF > 50% N=194Total N=1137At hospital discharge/at entry in the surveyBB78%/83%78%/85%62%/70%76%/82%Recommended BB†75%/77%72%/74%54%/62%71%/74%Reaching the target dose8%/16%7%/16%7%/13%7%/15%Changes since dischargeBB added*28%34%25%28%BB stopped**1%1%2%1%BB dose increased*27%27%17%25%BB dose decreased4%1%3%3%†metoprolol, nebivolol, bisoprolol, carvedilol ;*percentage calculated in patients without BB at hospital discharge (N=278);**percentage calculated in patients with BB at hospital discharge (N=859).ConclusionRate of betablockers prescription is high at hospital discharge. Outhospital cardiologists not only pursue but also amplify the care strategies defined during hospitalisation increasing the proportion of patients receiving BB and the percentage reaching the target dose

205 Ventricular arrhythmias in cardiac pacing patients multicentric study

Background and aimPatients implanted with dual chamber (DC) pacemakers (PM) have frequent episodes of arrhythmia. The interest of memory functions (MF) featuring EGM recordings to recognize and characterize these arrhythmias, particularly at the ventricular level, is still not well evaluated. The goal of this study is to establish the pertinence of MF at the ventricular level by repeated analysis at follow-up of the data recorded in the PM memories.Methods & ResultsA prospective series of 405 patients (76 +/− 10 yrs), M 59%, F 41% implanted with DC Kappa PMs (Medtronic, MN, USA) for atrio-ventricular block (37%) and sinus dysfunction (50%) were seen at two post implant semestrial follow-ups, at 6 months (F/u1) and at 12 months (F/u2). 83 pts (20%) at F/u1 and/or F/u2 showed ventricular tachycardias (VT) defined as at least 5 consecutive complexes at a frequency > 175bpm for a total of 102 follow-ups (17%). 55 pts (14%) showed VT at F/u1, 47 (12%) at F/u2 and only 19 (5%) at both F/u1 and F/u2. VT occurrence was statistically independent from mode switch episodes from the atrial level. Analysis showed that age, pacing indication, pacing mode and cumulated percentage of pacing are not factors in the presence of VT. In the VT group, 65% of patients present cardiopathy, with an ejection fraction of 54 +/− 17%. We observe that cardiopathy, is a statistical difference with the rest of the population of this study (52%, p<0.05).ConclusionIn our series, VT is frequent observed in 20% of PM patients implanted for standard indications at 6 and 12 months follow-ups. 2/3 of these patients show arrhythmia from the first 6 months f/u and 1/4 of these patients at both 6 and 12 months f/u. 1 year of follow up seems to demonstrate best sensitivity for VT detection. MF featuring EGM recordings are a tool for reliable diagnostic and monitoring of these events. Further studies are required to evaluate the prognostic significance of these arrhythmias

Review Article: Gastrointestinal Bleeding Risk with Direct Oral Anticoagulants

International audienc

0131: Strategy of anticoagulation in pacemaker and ICD replacement procedure in real life. The French Electra survey

Aimto evaluate routine French implanters strategy in device replacement in patients under anticoagulation for atrial Fibrillation (AF pts).MethodA questionnaire was e-mailed to 140 French implanters.Results102 aswers were obtained. In AF patients, admission is on day of procedure D0 (10%) or D-1(80%) whether pts are on vitamine K antagonist(VKA) or New Oral AntiCoagulant (NOAC). In AF pts under VKA, only 4%bridge to Low Weight Heparine (LWH) or Unfractionated Heparine (UH) while treatment is interrupted without substitution (wos) by 61% and continued without interruption by 32%. In AF pts under NOAC, only 5%bridge to UH or LWH while treatment is interrupted on D-3 (13%), D-2(25%), D-1(44%). When interrupted, NOAC are resumed at D0 (23%), D+1(54%), D+2(10%), D+3(3%).ConclusionsMost of implanters hospitalize AF pts at D-1 of replacement procedure. Short discontinuation (VKA, NOAC) or uninterruption (VKA) is prefered to bridging strategy

Management of outpatients in France with stable coronary artery disease. Findings from the prospeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease (CLARIFY) registry

Background: Improvements in the treatment of coronary artery disease mean that an increasing number of patients survive acute cardiovascular events and live as outpatients with or without anginal symptoms.&lt;p&gt;&lt;/p&gt; Aim: To determine the characteristics and management of contemporary outpatients with stable coronary artery disease in Western Europe, and to compare France with the other Western European countries.&lt;p&gt;&lt;/p&gt; Methods: CLARIFY (prospeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease) is an international, prospective, observational, longitudinal study. Between November 2009 and July 2010, 32,954 adult outpatients with stable coronary artery disease (defined as a history of documented myocardial infarction [of &#62; 3 months], prior coronary revascularization, chest pain with myocardial ischaemia, or coronary stenosis of &#62; 50% proven by angiography) were enrolled in 45 countries. The demographics and management of CLARIFY patients enrolled in France were compared with those enrolled in other Western European countries (Austria, Belgium, Denmark, Germany, Greece, Ireland, Italy, Netherlands, Portugal, Spain, Switzerland and the UK).&lt;p&gt;&lt;/p&gt; Results: Of the 14,726 patients enrolled in Western Europe (mean age 66.2 [10.2] years; 79.6% male), 2432 (16.5%) were from France. The use of aspirin was lower in France than in other Western European countries (74.5% vs. 86.9%, respectively), whereas use of thienopyridines (48.5% vs. 21.7%), oral anticoagulants (12.3% vs. 9.0%) and lipid-lowering drugs (95.8% vs. 92.5%) was higher. Beta-blockers were used in 73% of both groups. Angina was less prevalent in France (6.3% vs. 15.5%) and French patients showed higher levels of physical activity than their counterparts in Western Europe.&lt;p&gt;&lt;/p&gt; Conclusions: The management of patients with stable CAD in France appears favourable, with good adherence to guideline-based therapies, but there remains room for improvement in terms of symptom and risk factor control

Correlative analysis of vertebral trabecular bone microarchitecture and mechanical properties: a combined ultra-high field (7 Tesla) MRI and biomechanical investigation

International audienc

Gender-related differences in the management of hypertension by cardiologists: The PARITE study

SummaryBackgroundSeveral studies have shown gender differences in the management of cardiovascular risk factors and diseases. Whether the management of hypertension by cardiologists in France differs according to patient gender has not been fully investigated.AimsThe main objective of this cross-sectional, multicentre study was to examine the management according to gender of hypertensive patients by office-based cardiologists in France.MethodsCardiologists were asked to include consecutively two men and two women attending a routine consultation for essential hypertension. Therapeutic management was evaluated by comparing cardiovascular investigations in the preceding 6 months and hypertension control according to gender and the patients’ global cardiovascular risk.ResultsOverall, data from 3440 adult patients (53% men) referred to 654 cardiologists were analysed. Hypertension was uncontrolled in 76% of both men and women and 69% were at high global cardiovascular risk (75% of men, 62% of women; P<0.001). Significantly fewer cardiovascular investigations had been performed in the preceding 6 months in women (22.6% vs 44.2% in men; P<0.001). The treatment regimen was changed by the cardiologist in approximately 50% of patients regardless of gender or global cardiovascular risk.ConclusionsThe PARITE study shows that in French office-based cardiology practice, the antihypertensive regimen is adjusted as often in female as in male patients. However, the results suggest that there is room for improvement in the investigation of cardiovascular disease in women. Healthcare providers could be encouraged to implement established guidelines on the prevention of cardiovascular disease in women