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Brettell R.,University of Oxford | Soljak M.,Imperial College London | Cecil E.,Imperial College London | Cowie M.R.,Imperial College London | And 2 more authors.
European Journal of Heart Failure | Year: 2013

Aims Heart failure (HF) is an important clinical problem. Expert consensus has definedHFas a primary care-sensitive condition for which the risk of unplanned admissions may be reduced by high quality primary care, but there is little supporting evidence.We analysed time trends in HF admission rates in England and risk and protective factors for admission. Methods and results We used Hospital Episodes Statistics to produce indirectly standardized HF admission counts by general practice for 2004-2011. Clustered negative binomial regression analysis produced admission risk ratios and assessed the significance of potential explanatory covariates. These included population factors (deprivation; HF, coronary heart disease, and smoking prevalence), primary care resourcing [access; general practitioner (GP) supply], and primary care quality ('Quality and OutcomesFramework' indicator.) There were 327 756 HF admissions of patients registered with 8405 practices over the study period. There was a significant reduction in admissions over time, from 6.96/100 000 in 2004 to 5.60/100 000 in 2010 (P < 0.001). Deprivation and HF prevalence were risk factors for admission. GP supply and access protected against admission. However, these effectswere small and did not explain the large and highly significant annual trend in falling admission rates. Conclusions The observed fall in admissions over time cannot be explained by the primary care covariates we included. This analysis suggests that the potential for further significant reduction in emergency HF admissions by improving clinical quality of primary care (as currently measured) may be limited. Further work is required to identify the reasons for the reduction in admissions. © &The Author 2013 Published by Oxford University Press on behalf of the European Society of Cardiology.


Fournier C.,Institute National Of Prevention Et Deducation Pour La Sante Inpes | Fournier C.,University of Paris Descartes | Gautier A.,Institute National Of Prevention Et Deducation Pour La Sante Inpes | Mosnier-Pudar H.,Hopital University Cochin | And 3 more authors.
Education Therapeutique du Patient | Year: 2014

Introduction: Over the past decade, self-management education has emerged as an important priority in France. Under the term "therapeutic patient education", it has become compulsory for health care settings willing to implement self-management education programmes to be authorized according to national quality criteria and accreditation standards. Objectives: Our article summarizes data from a French national survey-ENTRED 2007-which aimed to assess to what extent self-management education was perceived by diabetic patients and their physicians to be part of the routine care to diabetic patients in France. Methods: Our study included a representative sample of 4,120 diabetic patients (of which 3,847 patients with type 2 diabetes and 273 patients with type 1 diabetes), as well as 2,392 physicians (of which 80% in primary care and 20% in specialised care). Results/Discussion: Our results show that despite incentives in relation to the preparation of the legal framework, there was still a lack of systematic implementation of self-management education as part of the routine medical care provided to patients with diabetes in 2007 in France. Moreover, we have evidenced discrepancies between patients' and physicians' perceptions regarding impact of diabetes on the patients' quality of life, performance of self-management tasks by patients, and patients' participation in decision-making processes. Such discrepancies call for sustained efforts to motivate and train healthcare providers to implement patient-centred self-management support interventions. © 2014 EDP Sciences, SETE.


Konrat C.,French Institute of Health and Medical Research | Boutron I.,French Institute of Health and Medical Research | Boutron I.,Center dEpidemiologie Clinique | Boutron I.,University of Paris Descartes | And 10 more authors.
PLoS ONE | Year: 2012

Background: We aimed to determine the representation of elderly people in published reports of randomized controlled trials (RCTs). We focused on trials of 4 medications-pioglitazone, rosuvastatin, risedronate, and valsartan-frequently used by elderly patients with chronic medical conditions. Methods and Findings: We selected all reports of RCTs indexed in PubMed from 1966 to April 2008 evaluating one of the 4 medications of interest. Estimates of the community-based "on-treatment" population were from a national health insurance database (SNIIR-AM) covering approximately 86% of the population in France. From this database, we evaluated data claims from January 2006 to December 2007 for 1,958,716 patients who received one of the medications of interest for more than 6 months. Of the 155 RCT reports selected, only 3 studies were exclusively of elderly patients (2 assessing valsartan; 1 risedronate). In only 4 of 37 reports (10.8%) for pioglitazone, 4 of 22 (18.2%) for risedronate, 3 of 29 (10.3%) for rosuvastatine and 9 of 67 (13.4%) for valsartan, the proportion of patients aged 65 or older was within or above that treated in clinical practice. In 62.2% of the reports for pioglitazone, 40.9% for risedronate, 37.9% for rosuvastatine, and 70.2% for valsartan, the proportion of patients aged 65 or older was lower than half that in the treated population. The representation of elderly people did not differ by publication date or sample size. Conclusions: Elderly patients are poorly represented in RCTs of drugs they are likely to receive. © 2012 Konrat et al.


Tuppin P.,Caisse Nationale dAssurance Maladie des Travailleurs Salaries CNAMTS | Ricci-Renaud P.,Caisse Nationale dAssurance Maladie des Travailleurs Salaries CNAMTS | De Peretti C.,Institute of Veille Sanitaire | Fagot-Campagna A.,Caisse Nationale dAssurance Maladie des Travailleurs Salaries CNAMTS | And 4 more authors.
Archives of Cardiovascular Diseases | Year: 2013

Background The frequencies of treatment for cardiovascular risk factors are poorly documented in large populations, particularly according to the presence or absence of cardiovascular disease (CVD). Aims To assess frequencies of reimbursements for antihypertensive, lipid-lowering and antidiabetic medications in France among national health insurance beneficiaries in 2010 and their associations according to age, sex, French regions, level deprivation and the presence of certain CVD. Methods Treatment frequencies were calculated among the beneficiaries (58 million people) on the basis of reimbursements for three specific categories of medicinal products in 2010. The presence of CVD was defined by a diagnosis associated with chronic disease status and hospital stays in 2010. Results Among people aged greater or equal to 20 years, treatment frequencies were 22% (men 20% vs. women 23%) for antihypertensives, 15% (14% vs. 16%) for lipid-lowering agents and 6% (6% vs. 5%) for antidiabetic medications. These frequencies were, respectively, 33%, 23% and 8% in patients aged greater or equal to 40 years and 55%, 38% and 14% in patients aged greater or equal to 60 years. The frequency of at least one treatment for at least one of the three risk factors was 41% in patients aged greater or equal to 40 years and 66% in patients aged greater or equal to 60 years. Among patients aged greater or equal to 20 years, 22% were treated for at least one risk factor in the absence of CVD and 3% were treated for at least one risk factor in the presence of CVD. Regional differences were observed, with higher frequencies of antihypertensive and antidiabetic use in the North, North-East and Overseas regions. Treatment frequencies increased with level of deprivation, especially for antidiabetics. Conclusion This national study more clearly defines treatment frequencies and the populations and regions with the highest treatment frequencies. © 2013 Elsevier Masson SAS.


Tuppin P.,Caisse Nationale dAssurance Maladie des Travailleurs Salaries CNAMTS | Cuerq A.,Caisse Nationale dAssurance Maladie des Travailleurs Salaries CNAMTS | De Peretti C.,Institute of Veille Sanitaire | Fagot-Campagna A.,Caisse Nationale dAssurance Maladie des Travailleurs Salaries CNAMTS | And 11 more authors.
Archives of Cardiovascular Diseases | Year: 2014

Background National population-based management and outcome data for patients of all ages hospitalized for heart failure have rarely been reported. Aim National population-based management and outcome of patients of all ages hospitalized for heart failure have rarely been reported. The present study reports these results, based on 77% of the French population, for patients hospitalized for the first time for heart failure in 2009. Methods The study population comprised French national health insurance general scheme beneficiaries hospitalized in 2009 with a principal diagnosis of heart failure, after exclusion of those hospitalized for heart failure between 2006 and 2008 or with a chronic disease status for heart failure. Data were collected from the national health insurance information system (SNIIRAM). Results A total of 69,958 patients (mean age, 78 years; 48% men) were studied. The hospital mortality rate was 6.4%, with 1-month, 1-year and 2-year survival rates of 89%, 71% and 60%, respectively. Heart failure and all-cause readmission-free rates were 55% and 43% at 1 year and 27% and 17% at 2 years, respectively. Compared with a reference sample of 600,000 subjects, the age- and sex-standardized relative risk of death was 29 (95% confidence interval [CI] 28-29) at 2 years, 82 (95% CI 72-94) in subjects aged < 50 years and 3 (95% CI 3-3) in subjects aged ≥ 90 years. For subjects aged < 70 years who survived 1 month after discharge, factors associated with a reduction in the 2-year mortality rate were: female sex; age < 55 years; absence of co-morbidities; and use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta-blockers, lipid-lowering agents or oral anticoagulants during the month following discharge. Poor prognostic factors were treatment with a loop diuretic before or after hospitalization and readmission for heart failure within 1 month after discharge. Conclusions This large population-based study confirms the severe prognosis of heart failure and the need to promote the use of effective medications and management designed to improve survival. © 2014 Elsevier Masson SAS.

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