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The management of chronic heart failure, following current guidelines, requires the implementation and adjustment of therapies to limit mortality and morbidity associated with disease progression. However, this period of treatment titration remains challenging due to the need for multiple, closely spaced consultations. The difficulty in maintaining this consultation frequency, coupled with the current decline in medical demographics, largely explains the lack of treatment titration or even initiation and the existing therapeutic inertia. Concurrently, medical telemonitoring is emerging as an essential tool in heart failure management, offering significant benefits for both patients and healthcare professionals.
In this context, new forms of nursing practices have emerged, such as advanced practice nursing, aimed at improving the care of patients with chronic diseases. However, only limited data are currently available regarding the functioning and impact of these consultations in France.
The "Evaluation and Support Pathway for Heart Failure Patients (FIL-EAS ic)" has systematically integrated this new model of consultations provided by heart failure nurse specialists. Given their significant and growing role within the pathway, it appears necessary to thoroughly evaluate these consultations to propose improvements and maximize their effectiveness.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Patients with chronic heart failure receiving consultations from a Heart Failure Specialist Nurse. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Heart Failure Specialist Nurses consultations | Other | Heart Failure Specialist Nurses consultations |
|
| Measure | Description | Time Frame |
|---|---|---|
| Type of consultation | Medical telemonitoring, treatment titration, advanced practice nurse follow-up | 1-year period |
| Patient's medical history | Patient's clinical characteristics will be analyzed : number and type of medical histories | 1-year period |
| Treatments implemented | Type and dose of treatment initiated for heart failure will be analyzed. | 1-year period |
| Number of consultations | The number of consultations will be analyzed by type of activity (medical telemonitoring, treatment titration, advanced practice nurse follow-up). | 1-year period |
| Number of hospitalizations | The number of hospitalizations and re-hospitalizations during the 12 months of follow-up will be analyzed. | 1-year period |
| Measure | Description | Time Frame |
|---|---|---|
| Type of referral | The type of referral will be analyzed : in-hospital (cardiology or non-cardiology) or out-of-hospital (cardiologist, general practitioner, private nurse or Advanced Practice Registered Nurse) | 1-year period |
| Reason for discontinuation of titration consultation |
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Inclusion Criteria:
Exclusion Criteria:
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Adult patient seen in nurse-led consultations for heart failure between January 1, 2023 and December 31, 2023
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| Name | Affiliation | Role |
|---|---|---|
| Mathilde LE CAIGNEC, Nurse | Centre Hospitalier Intercommunal Toulon La Seyne sur Mer | Study Director |
| Jocelyne CANDEL, Advanced Practice Nurse | Centre Hospitalier Intercommunal Toulon La Seyne sur Mer | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Centre Hospitalier Intercommunal Toulon La Seyne sur Mer | Toulon | Var | 83056 | France |
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The reason for the discontinuation of titration consultations will be analyzed. |
| 1-year period |
| Left ventricular ejection fraction (LVEF) | Echocardiography data during therapy titration will be analyzed. | 1-year period |
| Modification of recommended treatment doses | Modification of recommended treatment doses in heart failure will be analyzed in the overall cohort and according to the level of LVEF at initial management. | 1-year period |
| Rate of detection of iron deficiency | The rate of detection of iron deficiency will be analyzed according to whether or not Ferinject supplementation is used. | 1-year period |