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Congestive CHF is a very common pathology. Patients are often elderly and 25% are older than 80 years old. Physical disability is usual in this population and could increase the negative impact of CHF. The beneficial effect of physical training is still discussed especially in the elderly patients due to the low adherence of patients. We have developed a specific education program for years. This program includes a specific physical training and adherence of patients is measured every 6 month by a questionnaire and educative visit. The aim of our work is to determine the long-term adherence of elderly patients (CHF patients older than 80 years old) to our physical home training. We have analyzed through a questionnaire, physical examination and interview the adherence and the impact of practicing gymnastic and physical training in those patients. We have included more than 350 patients in our database and have selected all the patients older than 80 years old (75 patients). One year after the initial session, 75% of the patients have still an regular physical activity (non statiscally different from younger patients) and those with such “every week” training have a better performance to 6 minute walk test ( P < 0.05) and better clinical evolution than the “non adherent” patients ( P < 0.05). In conclusion it is possible to educate elderly patients to physical training and to maintain an acceptable adherence in elderly and very elderly patients. Six-minute walk test performance month after month is useful to evaluate easily this adherence. [ABSTRACT FROM AUTHOR]

Résumé L’insuffisance cardiaque est une pathologie grave et coûteuse marquée par de très nombreuses réhospitalisations. Nous avons analysé l’impact médico-économique du suivi des patients insuffisants cardiaques chroniques au décours d’une hospitalisation pour poussée aiguë par une unité thérapeutique d’insuffisance cardiaque versus la prise en charge usuelle actuelle en ville dans une étude rétrospective monocentrique sur 4855 patients consécutifs. Au terme de cette analyse, il apparaît que la prise en charge en unité thérapeutique d’insuffisance cardiaque diminue significativement les risques de réhospitalisations (réduction du RR : −28 % ; p = 0,001) mais aussi diminue de plus de 50 % les coûts liés aux hospitalisations ( p < 0,001), et ce quelles que soient les comorbidités ou la sévérité de la pathologie (définie par le nombre de réhospitalisations). Il apparaît donc que ces structures qui restent très rares en France comparativement aux autre pays devraient bénéficier d’un soutien institutionnel pour pouvoir se diffuser sur le territoire national. Chronic heart failure remains a frequent, severe and costly disease. Despite encouraging data from different countries, heart failure clinics are scarce in France. We have analyzed the impact of a heart failure clinic (UTIC of Pontoise) in terms of reduction of rehospitalizations and in hospitalization costs in 4855 consecutive patients. In our study, heart failure clinic management dramatically reduces HF related hospitalizations (RRR: −28 %, P = 0.001) and HF related costs (55% reduction, P < 0.001) regardless of comorbidities or disease severity. HF clinics have to be developed in France in order to optimize management of CHF and reduce the HF related costs. [ABSTRACT FROM AUTHOR]

Aim of the study. – To analyze the effect of bisoprolol in patients with stable congestive heart failure and who tolerated beta-blockers.Material and methods. – Two hundred and one patients performed before and 3 months after maximal tolerated doses of bisoprolol have been reached, a clinical evaluation, an echocardiography, a radionuclide angiography, a cardiopulmonary exercise test and hormonal determinations.Results. – Mean dose of bisoprolol was 8.8 ± 2.4 mg/d. Patients had a significant improvement in NYHA classification. Heart rate at rest decreased from 87 ± 17 to 66 ± 12 beats/min (P < 0.0001) without any effect on electrocardiographic parameters. Left ventricular ejection fraction improved from 31 ± 11 to 41 ± 13% (P < 0.0001), with a significant decrease in end-diastolic and end-systolic left ventricle diameters and volumes. Mitral profil improved. Peak VO2 increased from 16.1 ± 5 to 16.8 ± 5.5 ml/min/kg (P = 0.001) with a significant increase in O2 pulse (from 8.52 ± 2.7 to 11.2 ± 3.5 ml/min/beats, P < 0.0001). Plasma levels of A-type and of B-type natriuretic peptides and of norepinephrine significantly decreased after bisoprolol.Conclusions. – Bisoprolol significantly improved left ventricle ejection fraction with a reverse remodeling of the left ventricle, a decrease in hormonal activation and a modest improvement in exercise capacity. [Copyright &y& Elsevier]

Chronic heart failure patients education to self-management is recommended by international guidelines but is still underuse by clinicians. Actually only 5–10% of CHF patients benefit from multidisciplinary education in Europe. Many studies have underline the short- or mild-term impact of education on hospitalization but only few on mortality. The aim of our study was to analyse the long-term impact (8 years) of a structured multidisciplinary education of CHF patients and relatives using simple tools (paperboard, games, quiz) on all causes mortality. Methods We have prospectively included 803 consecutive CHF patients referred to our heart failure center since 2001. Patient education was proposed to all patients and was done only in 264. Education was done on Monday and Tuesday. Some refused and some were referred out of the education days. Education was based on an educational diagnostic done by a nurse, a discussion between doctor and a group of 6 patients and relatives and a discussion between physiotherapist and patients. At the end of the session, patients use a game tool analyzing reactivity and knowledge. We have followed the patients in the same way with the same clinicians in charge of optimizing HF therapy. Mean follow up was 8 ± 4 years. The main end point was all cause mortality. Results The two groups (Education vs no education) were comparable in term of age, LVEF (33 ± 11 vs 38 ± 13%) left ventricular filling (E/A 0,9 ± 0,2 vs 1,31 ± 1) renal function (creatininemia 114 ± 94 vs 116 ± 113 μmol/l) and BNP (313 ± 463 vs 533 ± 770 pg/mL)) and comparable in term of CH F therapies. During follow up, annual mortality rate was 3,19% in therapeutic education group versus 4,8% in the no education group ( p : 0,0369). Conclusion Education of CHF patients is a long-term effective tool in order to reduce long-term mortality. Our HF tool kit using face to face discussions and reactivity based games is not really time consuming (3 hours nurse/1 hour physiotherapist for a group from 6 to 8 patients) and is effective in order to reduce long term all cause mortality by 1/3. Due to its impact in real life, patient education to self-management should be promoted in CHF patient management and done in every HF center. [ABSTRACT FROM AUTHOR]

L’insuffisance cardiaque est une pathologie grave et coûteuse marquée par de très nombreuses réhospitalisations. Nous avons analysé l’impact médico-économique du suivi des patients insuffisants cardiaque chroniques au décours d’une hospitalisation pour poussée aiguë par une unité thérapeutique d’insuffisance cardiaque versus la prise en charge usuelle actuelle en ville dans une étude rétrospective monocentrique sur 4855 patients consécutifs. Au terme de cette analyse, il apparaît que la prise en charge en unité thérapeutique d’insuffisance cardiaque diminue significativement les risques de réhospitalisations (réduction du RR –28 % p = 0,001) mais aussi diminue de plus de 50 % les coûts liés aux hospitalisations ( p < 0,001) et ce quel que soient les comorbidités ou la sévérité de la pathologie (définie par le nombre de réhospitalisations). Il apparaît donc que ces structures qui restent très rares en France comparativement aux autre pays devraient bénéficier d’un soutien institutionnel pour pouvoir se diffuser sur le territoire national. [ABSTRACT FROM AUTHOR]