DOME-HF : évaluation rétrospective sur six mois de la prise en charge diurétique ambulatoire chez des patients âgés atteints d’insuffisance cardiaque

IF 0.3 Q4 Medicine

Annales de cardiologie et d'angeiologie Pub Date : 2025-09-22 DOI:10.1016/j.ancard.2025.101933

Marlène Esteban , Olivier Maurou , Marc Harboun , Sophie Nisse Durgeat , Rémi Esser

{"title":"DOME-HF : évaluation rétrospective sur six mois de la prise en charge diurétique ambulatoire chez des patients âgés atteints d’insuffisance cardiaque","authors":"Marlène Esteban , Olivier Maurou , Marc Harboun , Sophie Nisse Durgeat , Rémi Esser","doi":"10.1016/j.ancard.2025.101933","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Heart failure (HF) is a major cause of morbidity and mortality in older adults, with a rising prevalence after the age of 70. Conventional hospitalization, commonly required in this frail population, exposes patients to numerous iatrogenic complications. Alternative care models, such as diuretic-based day hospital (DH) management, may help mitigate these risks.</div></div><div><h3>Objectives</h3><div>To describe the geriatric profile of patients treated for acute heart failure (AHF) in a diuretic day hospital within a cardiogeriatrics unit, and to report the organization of the associated care pathway.</div></div><div><h3>Methods</h3><div>This was a retrospective, observational, monocentric study conducted in the cardiogeriatrics department of Hôpital La Porte Verte (Versailles, France). Patients aged ≥65 years who were treated in a diuretic day hospital for acute heart failure between January and June 2025 were included. Geriatric, cardiologic, and organizational data were collected from medical records. A purely descriptive analysis was performed.</div></div><div><h3>Results</h3><div>Forty patients were included, with a mean age of 88 ± 6.8 years. Most lived at home (95%) and had preserved autonomy (mean ADL score: 5.4). The average Charlson Comorbidity Index was 8.9 ± 2.3; 50% were at risk of malnutrition and 92.5% had chronic kidney disease. From a cardiologic standpoint, 57.5% had preserved LVEF and 67.5% had atrial fibrillation. The mean delay between referral and the first day hospital session was 1.6 days, with an average of 3.1 sessions per patient. The rate of subsequent full hospitalization was 12.5%. Main complications included electrolyte disorders (5%), non-catheter-related infections (7.5%), and acute kidney injury (7.5%). Following day hospital management, 22.5% of patients were enrolled in a geriatric frailty day hospital program, 32.5% in an intravenous iron day hospital, and 22.5% in a remote monitoring program.</div></div><div><h3>Conclusion</h3><div>This diuretic day hospital model, integrated into a structured geriatric care pathway, appears feasible, safe, and relevant for managing very elderly patients with acute heart failure. It may represent an effective alternative to conventional hospitalization.</div></div>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"74 5","pages":"Article 101933"},"PeriodicalIF":0.3000,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annales de cardiologie et d'angeiologie","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0003392825000721","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

Heart failure (HF) is a major cause of morbidity and mortality in older adults, with a rising prevalence after the age of 70. Conventional hospitalization, commonly required in this frail population, exposes patients to numerous iatrogenic complications. Alternative care models, such as diuretic-based day hospital (DH) management, may help mitigate these risks.

Objectives

To describe the geriatric profile of patients treated for acute heart failure (AHF) in a diuretic day hospital within a cardiogeriatrics unit, and to report the organization of the associated care pathway.

Methods

This was a retrospective, observational, monocentric study conducted in the cardiogeriatrics department of Hôpital La Porte Verte (Versailles, France). Patients aged ≥65 years who were treated in a diuretic day hospital for acute heart failure between January and June 2025 were included. Geriatric, cardiologic, and organizational data were collected from medical records. A purely descriptive analysis was performed.

Results

Forty patients were included, with a mean age of 88 ± 6.8 years. Most lived at home (95%) and had preserved autonomy (mean ADL score: 5.4). The average Charlson Comorbidity Index was 8.9 ± 2.3; 50% were at risk of malnutrition and 92.5% had chronic kidney disease. From a cardiologic standpoint, 57.5% had preserved LVEF and 67.5% had atrial fibrillation. The mean delay between referral and the first day hospital session was 1.6 days, with an average of 3.1 sessions per patient. The rate of subsequent full hospitalization was 12.5%. Main complications included electrolyte disorders (5%), non-catheter-related infections (7.5%), and acute kidney injury (7.5%). Following day hospital management, 22.5% of patients were enrolled in a geriatric frailty day hospital program, 32.5% in an intravenous iron day hospital, and 22.5% in a remote monitoring program.

Conclusion

This diuretic day hospital model, integrated into a structured geriatric care pathway, appears feasible, safe, and relevant for managing very elderly patients with acute heart failure. It may represent an effective alternative to conventional hospitalization.

查看原文本刊更多论文

DOME-HF：对老年心力衰竭患者门诊利尿剂管理的6个月回顾性评估

心衰（HF）是老年人发病和死亡的主要原因，70岁以后患病率上升。传统的住院治疗，通常需要在这个虚弱的人群，使患者暴露于许多医源性并发症。替代护理模式，如以利尿剂为基础的日间医院（DH）管理，可能有助于减轻这些风险。目的描述急性心力衰竭（AHF）患者在一家利尿日间医院的老年内科治疗的老年特征，并报告相关护理途径的组织。方法：这是一项回顾性、观察性、单中心研究，在Hôpital La Porte Verte （Versailles, France）心脏科进行。纳入2025年1月至6月期间在利尿日间医院治疗急性心力衰竭的年龄≥65岁的患者。从医疗记录中收集老年、心脏病和组织数据。进行了纯描述性分析。结果入选患者40例，平均年龄88±6.8岁。大多数人（95%）住在家里，并保持了自主性（平均ADL评分：5.4）。平均Charlson合并症指数为8.9±2.3；50%的人有营养不良的危险，92.5%的人患有慢性肾病。从心脏病学的角度来看，57.5%的患者保留了LVEF， 67.5%的患者有心房颤动。从转诊到第一天住院之间的平均延迟为1.6天，平均每位患者为3.1次。随后完全住院率为12.5%。主要并发症包括电解质紊乱（5%）、非导管相关感染（7.5%）和急性肾损伤（7.5%）。在日间医院管理之后，22.5%的患者入组了老年虚弱日间医院项目，32.5%入组了静脉注射铁日间医院项目，22.5%入组了远程监测项目。结论：将这种利尿剂日间医院模式整合到一个结构化的老年护理路径中，似乎是可行的、安全的，并且与管理高龄急性心力衰竭患者相关。它可能是传统住院治疗的一种有效替代方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Annales de cardiologie et d'angeiologie 医学-外周血管病

CiteScore

0.60

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Organe scientifique de référence fondé en 1951, les Annales de cardiologie et d''angéiologie abordent tous les domaines qui intéressent quotidiennement les cardiologues et les angéiologues praticiens : neurologie et radiologie vasculaires, hémostase, diabétologie, médecine interne, épidémiologie et prévention. Les Annales de cardiologie et d''angéiologie sont indexées aux grandes bases de données et publient rapidement, et en conformité avec les normes internationales de publication scientifique, des articles en français sur la pathologie cardiaque.