[Optimization of systolic heart failure treatment by general practitioners after hospital discharge: Are guidelines...

Heart failure is a common and serious disease, with constantly increasing incidence. General practitioners have an essential role in its management.

Describe general practitioner's practice in optimizing heart failure treatment after hospital discharge.

All patients admitted for heart failure with altered ejection fraction in Nanterre's hospital cardiology department between February 2014 and January 2015 and having a general practitioner were included. Demographic, clinical, biological, ultrasound data and treatments were collected. A questionnaire was submitted to general practitioners two months after discharge.

A total of 82 patients (age 76±12years, left ventricular ejection fraction 36±8%) were included. The target dose of angiotensin-converting-enzyme inhibitors and beta-blockers was reached for 18% of patients during hospitalization. Forty-two general practitioners answered the questionnaire, which concerned 60% of patients (n=49). None of them modified angiotensin-converting-enzyme inhibitors nor beta-blockers. The reasons were the lack of patient consultation (43%), the good tolerance (43%), the absence of habit (24%), and the attribution of this role to the cardiologist (41%). Possible improvements are: more precise hospitalization reports, alternating consultations and educational sessions.

Patients with heart failure are under-treated at discharge and general practitioners do not optimize the treatment after hospital discharge. The main axis of improvement is to establish a better defined care pathway.