144: Clinical and echographic characteristics of patients exposed to fenfluramin derivatives: Results of a prospective, monocenter observational study

ObjectivesFenfluramine derivatives have been associated with significant risk of developing cardiac valvulopathy. This prospective study evaluated characteristics of patients hospitalized in cardiology and who have been exposed to these drugs.MethodsBetween july 2011 and february 2012, patients admitted in the cardiology department, University Center of Montpellier, France, were questioned about past exposition to fenfluramine derivatives. In case of positive response, a questionnaire assessing prescribing patterns and previous medical history was proposed and echocardiography was performed. All usual echocardiographic parameters were analysed. We applied criteria from the French multicenter registry for diagnosis of drug-induced valvulopathy.ResultsNinety patients exposed to the drugs were included. Sixty-seven percent were women (n=60). Fifty-three percent had diabete (n=47). Ninety percent were exposed to benfluorex (n=81). Mean treatment duration was 48 months (IC95%; 36,5-60,2). Valvular regurgitations were observed in 62,2% of patients (n=51) while 19% of patients (n=15) had pulmonary hypertension. Distribution of valvulopathies is summarized in table 1. Highly probable induced valvulopathies were mild to moderate in all except 3 cases.ConclusionIn absence of definite knowledge about evolution of drug-induced valve disease, systematic questioning concerning fenfluramine derivatives use could be recommended in hospitalized patients.Table IDistribution of regurgitationsPatientsMitral RAortic RHP16 (20,3%)8 (10,7%)11 (14,3%)PI28 (34,1%)20 (24,4%)13(16,0%)UI22 (26,8%)15 (18,3%)11 (13,4%)(HP: highly probable induced regurgitations; PI: possibly induced regurgitations; UI: unlikely induced regurgitations; R: regurgitation

0214: Classifying heart failure patients to describe outpatient and inpatient care pathways in the French region Languedoc-Roussillon. First results of the cohort named “CarPathes”

IntroductionCare pathways are quickly developing involving hospital and out-of hospital cares for patients with heart failure (HF). To improve the clinical managment and optimize the insurance economics, we aimed at decribing the care pathways and the consistency with clinical status and care access.MethodsA retrospective cohort of patients living in the French region Languedoc-Roussillon was built. Inclusion criteria were mainly: first admission for HF in 2012; follow-up more than 1 year. The database we used (the SNIIRAM) include outpatient care claim data and hospitalization data. Patients were classified by a hierarchical ascending classification on principal components, using variables describing clinical status, use of specialized and non-specialized care, and main clinical outcomes (hospitalization, death).Results2751 patients were included and followed during a median of 22 months. Mean age was 78, 484 (18%) died, 818 (30%) were readmitted at least once for heart failure. The cluster analysis revealed three different significant groups: 1/ group 1 (N=734) is characterized by a younger age, more cares with cardiologists and less main clinical outcomes. Groups 2 and 3 are not different as regards age and comorbidities. 2/group 2 (N=1060) differs from the group 3 (N=957): less cares out-of the hospital contrasting with more cares at hospital, especially at emergencies.ConclusionThis cohort enables to evaluate consistency and adequation between cares and clinical status, following mail clinical outcomes. As this cohort is built in a heterogeneous region in terms of medical density or health organization, it should be a powerful tool for the study of spatial determinants

The Intensity of Primary Care for Heart Failure Patients: A Determinant of Readmissions? The CarPaths Study: A French Region-Wide Analysis

<div><p>Background</p><p>We aimed to classify patients with heart failure (HF) by the style of primary care they receive.</p><p>Methods and Results</p><p>We used the claim data (SNIIRAM: Système National d’Information Inter-Régime de l’Assurance Maladie) of patients living in a French region. We evaluated three concepts. First, baseline clinical status with age and Charlson index. Second, primary care practice style with mean delay between consultations, quantity of nursing care, and variability of diuretic dose. Third, clinical outcomes with death during follow-up, readmission for HF, and rate of unforeseen consultations. The baseline clinical status and the clinical outcomes were included to give an insight in the reasons for, and performance of, primary care practice style. Patients were classified using a hierarchical ascending classification based on principal components. A total of 2,751 patients were included in this study and were followed for a median of 22 months. The mean age was 78 y (SD: 12); 484 (18%) died, and 818 (30%) were readmitted for HF. We found three different significant groups characterized by their need for care and the intensity of practice style: group 1 (N = 734) was “low need-low intensity”; group 2 (N = 1,060) was “high need-low intensity”; and group 3 (N = 957) was “high need-high intensity”. Their readmission rates were 17%, 41% and 28%, respectively.</p><p>Conclusions</p><p>This study evaluated the link between primary care, clinical status and main clinical outcomes in HF patients. In higher need patients, a low-intensity practice style was associated with poorer clinical outcomes.</p></div

Exploring collagen remodeling and regulation as prognosis biomarkers in stable heart failure

International audienceWe assessed the predictive ability of circulating biomarkers involved in collagen synthesis (procollagen type I N-terminal propeptide [PINP], and procollagen type III N-terminal propeptide [PIIINP], collagen degradation (c-terminal telopeptide of collagen type I [CTx] and mediators of cardiac fibrosis (Galectin-3 and soluble suppression of tumorigenicity 2 protein or sST2) as prognosis markers in 182 subjects with chronic heart failure (HF). In univariate analysis, all markers predicted mortality (except for PINP). A multivariate baseline model was fitted including variables potentially associated with mortality in HF patients. The baseline regression model included age, clinical data and biomarkers. We created four models from the baseline model augmented with the levels of hs-cTnT, CRP and NT-proBNP (model 1), CTx/PIIINP ratio, sST2 and Galectine-3 (model 2), NT-proBNP and sST2 (model 3) and NT-proBNP, CTx/PIIINP ratio and sST2 (model 4), to test whether these biomarkers have an incremental value for predicting mortality. After the addition of all biomarkers to the baseline model, age, CTx/PIIINP ratio and sST2 remained significant predictors. By contrast, Galectin-3 was not significantly associated with mortality. A multimarker strategy, demonstrated that the greatest prognostic improvement was attained with the combined addition of CTx/PIIINP ratio and sST2 highlighting the potential role of fibrosis pathways in risk stratification

Group characteristics.

Group characteristics.</p

Flow Diagram.

<p>Flow Diagram.</p

Population characteristics (quantitative variables).

<p>Population characteristics (quantitative variables).</p

Scatter plot of individuals in the first two plans of the MCA.

<p>Scatter plot of individuals in the first two plans of the MCA.</p

Population characteristics (qualitative variables).

<p>Population characteristics (qualitative variables).</p

Flow Diagram.

<p>Flow Diagram.</p