Étude de l’exposition médicamenteuse aux cardiotropes des sujets âgés consultant aux urgences pour chute avec malaise en Rhône-Alpes [Study of cardiovascular drugs usage, among elderly subjects admitted to the emergency department for syncopal falls in Rhône-Alpes region]

Study of cardiovascular drugs usage, among elderly subjects admitted to the emergency department for syncopal falls in Rhône-Alpes region. Polypharmacy and cardiovascular medication usage are risk factors for falls in the elderly. This study included subjects aged 75 and over, admitted in the emergency department for falls, based on evaluation data of professional practices carried out in the Nord Alpine region by the French Network of North-Alps Emergency Departments (Réseau Nord Alpin des Urgences, RENAU). The patients included were divided into 4 groups: "syncope", "accidental falls", "repeated falls" and "other types of fall". From the emergency room admission prescriptions, we studied the consumption of cardiovascular drugs in number and quality in the "syncope" group compared to other types of falls. The main objective in this study was to highlight higher cardiovascular drug usage among the elderly patients admitted to the emergency department for syncopal falls, in comparison with other types of falls. We included 1,476 patients among whom 262 patients came for "syncopal falls". We found superior usage of cardiovascular medication among syncopal falls compared to other type of falls (p < 0,01). However, there is no statistically significant association between inappropriate cardiovascular drug prescriptions, and the type of falls. The "standardized" fall assessment whose orthostatic hypotension investigation, is not always exhaustive in the emergency room. Orthostatic hypotension diagnostic is insufficiently sought in the emergency room. This study highlights a significantly higher usage of diuretic medication within the syncope group, in comparison to the other groups, and especially loop diuretic. Antihypertensive drugs (angiotensin-converting enzyme inhibitor, angiotensin II receptor blockers, calcium inhibitor) are also recurrent within the syncope group compared to the others. A careful supervising of these prescriptions among elderly patients seems required. These data prompt to revise prescriptions during fall related hospitalizations, and then with the primary-care physician, or with the cardiologist

Sequentiality of Daily Life Physiology: An Automatized Segmentation Approach

International audience: Based on the hypotheses that (1) a physiological organization exists inside each activity of daily life and (2) the pattern of evolution of physiological variables is characteristic of each activity, pattern changes should be detected on daily life physiological recordings. The present study aims at investigating whether a simple segmentation method can be set up to detect pattern changes on physiological recordings carried out during daily life. Heart and breathing rates and skin temperature have been non-invasively recorded in volunteers following scenarios made of "daily life" steps (13 records). An observer, undergoing the scenario, wrote down annotations during the recording time. Two segmentation procedures have been compared to the annotations, a visual inspection of the signals and an automatic program based on a trends detection algorithm applied to one physiological signal (skin temperature). The annotations resulted in a total number of 213 segments defined on the 13 records, the best visual inspection detected less segments (120) than the automatic program (194). If evaluated in terms of the number of correspondences between the times marks given by annotations and those resulting from both physiologically based segmentations, the automatic program was better than the visual inspection. The mean time lags between annotation and program time marks remain <60 s (the precision of annotation times marks). We conclude that physiological variables time series recorded in common life conditions exhibit different successive patterns that can be detected by a simple trends detection algorithm. Theses sequences are coherent with the corresponding annotated activity