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

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

Predictors of hospital discharge and mortality in patients with diabetes and COVID-19: updated results from the nationwide CORONADO study

AIMS/HYPOTHESIS: This is an update of the results from the previous report of the CORONADO (Coronavirus SARS-CoV-2 and Diabetes Outcomes) study, which aims to describe the outcomes and prognostic factors in patients with diabetes hospitalised for coronavirus disease-2019 (COVID-19). METHODS: The CORONADO initiative is a French nationwide multicentre study of patients with diabetes hospitalised for COVID-19 with a 28-day follow-up. The patients were screened after hospital admission from 10 March to 10 April 2020. We mainly focused on hospital discharge and death within 28 days. RESULTS: We included 2796 participants: 63.7% men, mean age 69.7 ± 13.2 years, median BMI (25th-75th percentile) 28.4 (25.0-32.4) kg/m(2). Microvascular and macrovascular diabetic complications were found in 44.2% and 38.6% of participants, respectively. Within 28 days, 1404 (50.2%; 95% CI 48.3%, 52.1%) were discharged from hospital with a median duration of hospital stay of 9 (5-14) days, while 577 participants died (20.6%; 95% CI 19.2%, 22.2%). In multivariable models, younger age, routine metformin therapy and longer symptom duration on admission were positively associated with discharge. History of microvascular complications, anticoagulant routine therapy, dyspnoea on admission, and higher aspartate aminotransferase, white cell count and C-reactive protein levels were associated with a reduced chance of discharge. Factors associated with death within 28 days mirrored those associated with discharge, and also included routine treatment by insulin and statin as deleterious factors. CONCLUSIONS/INTERPRETATION: In patients with diabetes hospitalised for COVID-19, we established prognostic factors for hospital discharge and death that could help clinicians in this pandemic period. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT04324736