Patient Care Management Strategies for Severe Heart Failure in Rhône-Alpes, France.

Not Applicable

Completed

Interventions: Other: "As usual " patient care management
Other: PRETICARD patient care management

Brief Summary: The heart failure is a chronic pathology with prevalence from 2 to 3% of general population, a death rate of 50% at 6 months for patients with stage IV, and a probability of death or hospitalization or emergency consultation of 40% at 3 years. The care of patients is heterogeneous, especially in light of the organization of therapeutic education offered to patients and patient monitoring modalities.

The aim of this study is to investigate the management strategies for patients with chronic heart failure stage III or IV NYHA, and heart failure patients with stage II NYHA with previous hospitalization for heart failure.

This is a longitudinal observational multicenter study comparing a management strategy including patient education and monitoring as part of a hospital dedicated organization and an organization of care as usually done in France.

The primary endpoint was a composite endpoint of morbidity and mortality involving deaths, unplanned readmissions and emergency visits for heart failure.

The expected number of patients is 720 patients (360 per strategy). The follow-up duration of 24 months.

Recruitment & Eligibility

Inclusion Criteria

Chronic heart failure patient with left ventricular ejection fraction (LVEF) defined by an impaired LVEF less than or equal to 40%.
Heart failure stage III or IV NYHA, or heart failure patients with stage II NYHA with previous hospitalization for heart failure.
Patient who has received a written or oral information of the study
Patient affiliated with French health Insurance

Exclusion Criteria

Patient refusal to participate in the study
Progressive neoplastic pathology.
Patient with impaired cognitive functions known.
Patient subject to a measure of socio-legal protection.
Heart failure secondary to curable causes (an arrhythmia, valvular dysfunction, myocardial infarction, bypass surgery scheduled, aortic stenosis, breaking rope...)
Dyspnea pulmonary origin: pulmonary arterial hypertension pre-capillary origin catheterization, defined by a Pcap ≤15 mmHg.
Patient who underwent ventricular mechanical assistance.
Patient with acute breathlessness is explained by: a severe lung infection (CPT <60% of predicted, ventricular ejection fraction <60% predicted) or pulmonary embolism or respiratory failure with ambient air PaO2 (arterial oxygen pressure) below 60 mmHg or oxygen therapy.
Dialysis patient

Arm && Interventions

Group	Intervention	Description
Control	"As usual " patient care management	Heterogenous "as usual" patient care management.
Interventional	PRETICARD patient care management	PRETICARD patient care management

Primary Outcome Measures

Name	Time	Method
Composite endpoint combining the proportion of patients who died, the proportion of hospitalization for heart failure as well as the proportion of emergency visits for heart failure.	12 months

Secondary Outcome Measures

Name	Time	Method
Unplanned re hospitalization rate or emergency consultations for cardiac insufficiency.	At 6, 18 and 24 months
Cost of medical care	24 months	Identification of expenditure: * Hospitalizations * Consultations (inpatient and outpatient) * Biology and imaging * Medical transport
Quality of life.	12 months	MINNESOTA Questionnaire.
Satisfaction.	3 months	Semi-structured interviews.

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