Prise en charge thérapeutique de l'insuffisance cardiaque sévère : description , déterminants et interaction avec le pronostic

Abstract : Heart failure remains a serious problem of public health in the industrialized countries. Ils prevalence and its incidence increase in parallel with the ageing of the population. Many clinical trials have demonstrated the incontestable benefice of drugs as angiotensin converting enzyme inhibitors or betablockers. Nevertheless, the epidemiological studies show that results don't always applied in clinical practice. The aim of our work was to describe the therapeutic treatment of severe heart failure patients, to identify its determinants and its interactions with the prognosis. Our work concerned a prospective cohort of 499 severe heart failure patients, with the age of 65 years on average identified in Lorraine in 1994 in th EPICAL (Epidémiologie de l'Insuffisance Cardiaque Avancée en Lorraine) study. Among 417 patients surviving afier the index hospitalization with completed treatment records, 75% took angiotensin converting enzyme inhibitors but 40% at non optimal doses. The independent factors ofnon prescription were old age and renal impairment. The one and five years survival rate were respectively 75% and 36%. Oral anticoagulants, aspirin, lipid lowering and beta-blackers prescriptions were assbciated with a better survival rate at five years. These results underline: 1. The hiatus that exists between the recommendations based on proofs from clinical trials and the real prescriptions described in our observational study. The discrepancies are ofien in relation to patients without fair representation (subjects very old) or ta patients excluded (kidney failure) from clinical trials. 2. The need of prospective randomised trials with antithrambotic therapy in the treatment of chronic heart failure.
Mots-clés : Insuffisance cardiaque
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Theses
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Submitted on : Friday, March 30, 2018 - 9:48:38 AM
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Muriel Echemann. Prise en charge thérapeutique de l'insuffisance cardiaque sévère : description , déterminants et interaction avec le pronostic. Médecine humaine et pathologie. Université Henri Poincaré - Nancy 1, 2002. Français. ⟨NNT : 2002NAN11301⟩. ⟨tel-01754420⟩

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