Optimized Medico-pharmaceutical Collaboration in the Drug Management of Patients With Heart Failure

Interest of an Optimized Medico-pharmaceutical Collaboration in the Drug Management of Patients With Heart Failure: Controlled, Randomized, Multicentric Study

This is a controlled, randomized, open-label, multicentric study evaluating the value of coordinated medico-pharmaceutical management compared to standard management in patients with heart failure. The aim of this study is to evaluate the impact of these optimized activities on the re-hospitalization of the patient with cardiac insufficiency for a disease-related event within three months of the initial hospitalization.

Heart failure (FH) is a public health problem with an estimated prevalence of about 1.5% in developed countries. In 2013, the number of patients hospitalized in France for heart failure amounted to 165 231 and 20% of them were re-hospitalized at least once for the same reason during this year. Several factors contribute to the occurrence of cardiac decompensation (DC) : some modifiable (age, severity of IC, etiology ...) and others modifiable, such as therapeutics. Various elements could reduce the frequency of re-hospitalizations and the mortality due to this disease :

• a better knowledge of treatments by patients and consequently a better therapeutic compliance
• a better knowledge of the factors and signs of DC (low-sodium diet, weighing...)
• a better implementation of prescribing recommendations : less than 50% of patients have optimal treatment compared to ESC recommendations
• a better communication at the transition points of the patient pathway. The creation of a binomial cardiologist-clinical pharmacist during hospitalization and the maintenance of this optimized multidisciplinary follow-up within 3 months post-hospitalization is a proposal to intervene on these factors. Indeed, the clinical pharmacist (present in the care unit) works in collaboration with the medical and paramedical teams and can improve the care of patients. In the experimental group, a specific multidisciplinary consultation is planned for one month after the end of the hospitalization. A 3-month follow-up visit will be carried out by phone call to meet the criteria for readmission, mortality, quality of life, adherence and persistence of treatments.

Inclusion Criteria:

• Patient aged more than 18 years
• Adult patient admitted in cardiology department (full hospitalisation or intensive care) for heart failure no matter the type and the stage of the disease
• Person affiliated or beneficiary of a social security system
• Collection of a free, informed, express and written consent

Exclusion Criteria:

• Non autonomous drug management patients and not disposing
• a present caregiver during hospitalisation
• Patients living in an institution
• Person participating in another clinical trial with an exclusion period still ongoing
• Person whose physical and/or psychological health is severely altered, and which, in the opinion of the investigator, may affect the participation's to the study
• Person deprived of his rights, person under tutorship or guardianship
• Refusal to sign the consent