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Etudes pronostiques : application à l'insuffisance cardiaque sévère (étude EPICAL)

Abstract : This work presents general princip les and rnethodology of prognostic studies and their application to the EPICAL cohort. EPICAL (EPidémiologie de l'Insuffisance Cardiaque Avancée en Lorraine) is an observational prospective population-based study, which included 499 severe systolic heart failure patients, followed during five years. Patients were recruited from an annual exhaustive recording in a French region. Our work comprised three stages : 1) The patients characteristics were described and the extreme gravity of this disease was underlined (five-years mortality was 69%), 2) The clinical, paraclinical and therapeutic factors related to survival were highligh ted (age, hyponatremia, hypercreatininemia, duration of causal disease, prior decompensation, severe comorbidity, high diuretic doses). From these factors, we elaborated a prognostic score. This score separates the patients in three groups : high risk of death (87% to 5 years), intermcdiate risk (62% to 5 years) and weak risk (23% to 5 years). We validated this score on an independent sample of patients from the RALES trial. 3) The progno stic value of quality of Iife assessments on mortality and re-hospitalization were shown : a ten-points (out of 100) decrement in quality of life score was associated with a 23% to 36% increase in the risk of death or rehospitalisation for heart failure. These assessments were realized with two tools adapted and validated in French : Our study enabled to describe the evolution of severe heart failure and to provide tools for the prognostic stratification in c1inical practice.
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Submitted on : Thursday, March 29, 2018 - 10:47:18 AM
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François Alla. Etudes pronostiques : application à l'insuffisance cardiaque sévère (étude EPICAL). Médecine humaine et pathologie. Université Henri Poincaré - Nancy 1, 2002. Français. ⟨NNT : 2002NAN11302⟩. ⟨tel-01746903⟩



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