Nancy. Heart failure: a Lorraine study reveals that cardiological monitoring increases lifespan

Cardiologists and researchers at the Centre for Multi-Thematic Clinical Investigation (CIC-P) at the Nancy University Hospital , ^Professor Nicolas Girerd and Dr. Guillaume Baudry, conducted a study in association with the National Health Insurance Fund (CNAM) and national experts on the importance of cardiological monitoring in patients with heart failure. Present in May in Belgrade at the European Heart Failure Congress, the Nancy team presented the results of several of their studies, some of which were published almost simultaneously in the leading scientific journal "European Heart Journal (EHJ)".

This is the case of the investigation carried out on a cohort of 655,919 patients identified as having heart failure on January ^1, 2020. The group of cardiologists and statisticians analyzed the medical follow-up of these patients over two years. They came to the conclusion that an incomplete or even non-existent cardiological consultation significantly undermined the prognosis of patients, while the severity of their illness would require "optimizing the overall management of the disease," indicates ^Professor Nicolas Girerd , coordinator of the CIC-P. This insufficient recourse to cardiological care would worsen the prognosis of heart failure.

1.5 million people with heart failure

France has more heart failure patients than the 655,919 listed in the CNAM files. "We estimate there are 1.5 million," says Nicolas Girerd. Cardiologists found that 40% of the 655,919 patients examined had not seen a cardiologist within a year, or 1 in 2.5 patients. "These are generally slightly older patients, more often women," explains Nicolas Girerd. During follow-up, the "difference is clear between those who see a cardiologist within a year and those who do not: the gap is 6 to 9% mortality at one year," emphasizes the cardiologist. It was thus observed that patients hospitalized less than a year ago who do not see a cardiologist have a 34% risk of dying within a year, compared to 27% for those who see a cardiologist once. Those who were not hospitalized and were not on diuretics, the rate dropped from 13% to 7%, depending on whether or not they were receiving cardiological monitoring.

What does this study reveal beyond the observation? "These results lead us to believe that there may be difficulties in organizing care, which vary from one region to another, and which obviously influence patient care," suggests Nicolas Girerd. Another possible explanation for the prognosis gaps: "The differentiated use of treatments." "Cardiologists are increasingly using the new molecules available to treat heart failure, particularly heart failure with impaired ejection fraction. These treatments, which have become more complex over the past fifteen years, require the specific expertise of cardiologists. Their more intensive and tailored prescription could partly explain the observed differences in mortality."

The question remains how to do better with the declining number of cardiologists. "To optimize resources," the study recommends, "we should have one consultation per year for those at low risk, two or three consultations for patients at medium risk, and four consultations for patients at very high risk. We should be graduating, but we observe that this hierarchy does not currently exist." "The simple prognostic tool we are proposing could help guide the frequency of consultations," Nicolas Girerd extrapolates. The next step will be to confirm these initial observations by verifying whether implementing regular cardiological monitoring in patients who do not have it improves their survival or whether the differences are due to overinterpretation.