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Biomedical subjects

F Delahaye

Publications and source records attributed to F Delahaye.

At least 37 records · Page 2Linked to original sources
PubMed2001

Impact of selected geographical and clinical conditions on thrombolysis rate in myocardial infarction in three departments of France.

Our objective was to assess the impact of selected geographic factors and patients' characteristics on thrombolysis rates in patients resident and hospitalised for acute myocardial infarction in three departments of the Rhĵne-Alpes Region (France). We used a two-level hierarchical model to estimate and explain geographic areas' specific effects. Old subjects and women were less frequently treated than young subjects and men. Severe, non-anterior and non-Q-wave myocardial infarctions were associated with lower thrombolysis rates. It was also lower in patients with a pulmonary chronic disease, a cancer, a peripheral arterial disease, a history of cerebrovascular accident or transient ischaemia attack, and in patients with a psychiatric disorder. After adjusting for patients' characteristics, significant variations in thrombolysis rates remained between geographic areas (up to 3.2 times). These variations seem to be partly explained by distance or isolation: a longer distance to the closest hospital or a high degree of isolation seem to lower the probability of thrombolytic therapy. Several other sources of treatment variation between the studied geographic areas remain unexplored. These factors, especially those that augment the delay to treatment, are to be identified in order to augment fibrinolysis usage and reduce inter-area heterogeneity.

Age Factors↗
PubMed2001

Treatment at discharge after myocardial infarction in 2,102 patients. The PRIMA study. Prise en charge de l'Infarctus du Myocarde Aigu.

OBJECTIVE: This study sought to examine the use of treatments at discharge in patients hospitalized for myocardial infarction in a French region. METHODS AND RESULTS: Data from 2,102 patients discharged after myocardial infarction were prospectively collected at 48 university, community, and private hospitals in three departments in the Rh ne-Alpes region between September 1, 1993 and January 31, 1995. Beta-blockers were prescribed in 59% of the patients, calcium channel blockers in 22%, nitrates in 59%, antiplatelet agents in 82%, anticoagulants in 26%, angiotensin-converting enzyme inhibitors in 36%, diuretics in 33%. Beta-blockers were prescribed less often in older patients, and in patients with higher Killip classes or a history of pulmonary disease. Calcium channel blockers were prescribed more often in older patients, and in patients with a history of diabetes, pulmonary disease, or non-Q wave myocardial infarction. Nitrates were prescribed more often in older patients. Angiotensin-converting enzyme inhibitors were prescribed more often in patients with a history of diabetes, hypertension, or anterior myocardial infarction, and less often in patients with a history of renal failure. Diuretics were prescribed more often in older patients, and in patients with a history of renal failure, diabetes, hypertension, or higher Killip classes. CONCLUSIONS: There is still underuse of beneficial treatments, particularly in elderly patients.

Adrenergic beta-Antagonists↗
PubMed2001

Are women with acute myocardial infarction managed as well as men? Does it have consequences on in-hospital mortality? Analysis of an unselected cohort of 801 women and 1,718 men.

OBJECTIVE: This study sought to compare characteristics and management of myocardial infarction in men and women, and whether a difference in management would translate into a difference in in-hospital mortality. METHODS AND RESULTS: Data were prospectively collected in 2,519 patients (801 women) admitted in all hospitals in three departments in the Rhĵne-Alpes region in France between September 1, 1993 and January 31, 1995. Women were older than men (76 vs. 64 years). The interval between symptom onset and initial medical intervention was longer in women than in men (median: 180 vs. 135 minutes), as was the interval between symptom onset and hospital admission (median: 315 vs. 255 minutes). After age-adjustment, women were less often smokers, and more often hypertensive or diabetic than men, location of infarction was more often anterior in women, as congestive heart failure at admission. In multivariate analysis, thrombolysis rate was not significantly different in both sexes, whereas noninvasive tests, coronary arteriography, percutaneous transluminal coronary angioplasty, and coronary artery bypass grafting were significantly less often performed in women than in men. Although in-hospital mortality was higher in women than in men (21% vs. 11%), this difference disappeared after age-adjustment (relative risk = 0.99). In multivariate analysis, gender was not an independent predictor of survival. CONCLUSIONS: Although in-hospital mortality after myocardial infarction was similar in both sexes, rates of diagnostic and therapeutic procedures were lower in women than in men. This raises the question of whether mortality would decrease in women if management were similar in both sexes.

Age Factors↗
PubMed2001

Thrombolysis in myocardial infarction in a prospective cohort of 2,515 consecutive patients: older age and longer delays lead to a lower thrombolysis rate.

OBJECTIVE: This prospective study sought to determine the rate of thrombolysis in myocardial infarction and the factors that influenced it in everyday practice. METHODS AND RESULTS: Data were prospectively collected in all patients admitted in all (48) university, community, and private hospitals in three departments in the Rhĵne-Alpes region in France between September 1, 1993 and January 31, 1995. Data from 2,515 patients were included. Overall, 36% of the patients received thrombolysis. The decrease of the thrombolysis rate with age was very regular. The difference between men and women disappeared almost completely when age was taken into account in a bivariate analysis. Among 19 variables introduced in the logistic regression, only the following ones were significant predictors (odds ratio < 1 means less thrombolysis): age (odds ratio: 0.60 per decade), administrative department, type of hospital (community/tertiary: 0.74; private/tertiary: 0.58), history of myocardial infarction or of angina pectoris (0.67), location of myocardial infarction (Q wave non anterior/Q wave anterior: 0.75; non Q wave/Q wave anterior: 0.18), delay between symptoms onset and first medical intervention (0.06), history of cancer (0.47), and history of psychiatric disorder (0.38). CONCLUSIONS: In France as in other countries, the rate of thrombolysis is low. In order to increase this rate, we have to find ways to be more "aggressive" in older patients, and to precisely describe the health care pathways in order to shorten delays.

Age Distribution↗
PubMed2001

[Observations on the management of cardiac failure in ambulatory patients. Results of a survey of cardiologists].

An enquiry was undertaken amongst 71 cardiologists in 1999 evaluating 600 ambulatory patients with cardiac failure (64% men; mean age 73 years; NYHA Class I: 9%, Class II: 52%, Class III: 33%, Class IV: 6%). Cardiac failure is commoner in men (81%) before the age of 70. After the age of 80, the tendency is inversed (53% of women). Fifty-two per cent of patients had a history of hospital admission for cardiac failure: 26% in the year before the enquiry (on average 13.1 days' hospital stay). On inclusion, the diagnosis was made 4.2 +/- 4.6 years previously and the patients had been followed up for an average of 3.04 +/- 3.3 years. The diagnosis of cardiac failure was made by the cardiologist (57%), the general practitioner (37%), or another category of physician (6%). Eight per cent of patients were treated with a single drug before inclusion, 22% had a bi-therapy and 70% a polytherapy. The most frequently prescribed drugs were: diuretics (71%), angiotensin converting enzyme (ACE) inhibitors (54%) and digitalis (35%). The prescription of betablockers was only reported in 14% of the population. In the over-80's, only 45% of patients were prescribed ACE inhibitors. These results confirm that ambulatory patients with cardiac failure are mainly in NYHA Classes II and III, that the pathology concerns elderly patients and that it is the cause of recurrent hospital admission. The prescription of diuretics is the main therapy in all NYHA Classes. ACE inhibitors were only prescribed in 2/3 of patients and in less than half of patients over 80 years of age. The prescription of betablockers remains marginal. The reason for the underprescription of recommended drugs (International Recommendations) would justify further investigation.

Adrenergic beta-Antagonists↗
PubMed2001

[Secondary prevention of coronary artery disease with lipid-lowering drugs].

Before the statins era, this was one of the most debated questions in the field of cardiology: although hypolipidemic drugs (mainly fibrates) decreased the cardiovascular morbidity and mortality, their influence on total mortality was not significant. The 4S study demonstrated the efficacy of a statin on cardiovascular morbidity and mortality and on total mortality. This was confirmed by the CARE and the LIPID trials. Statins should be prescribed to all coronary patients, whatever the type of coronary disease, the age (we do not know yet for people older than 80), the gender, the basal cholesterol level (maybe statins are not efficacious when it is<2g/l); cholesterol level has to be lowered below 2g/l. Two trials of drugs increasing the HDL cholesterol level were recently published. Unfortunately their results are contradictory. Statins should be the first level drugs. Maybe it is useful to decrease the triglycerides level and to increase the HDL cholesterol level. The association of a statin and a fibrate is reserved to specialized centers. We should not forget the usefulness of diet. We must also take the other risk factors into account.

Age Distribution↗
PubMed2001

[Epidemiology and prognosis of cardiac insufficiency].

Cardiac insufficiency, the outcome in the majority of cardiac diseases, is common and serious. The frequency is rising, and the fatality, even if it has diminished thanks to various treatments, remains elevated. The epidemiology of cardiac insufficiency is relatively little known in France, despite its considerable economic impact on the health system, while this constraint is ever increasing. Some significant French statistics: the number of cardiac insufficiency cases is about 500,000, there are 120,000 new cases each year. The incidence rises from 4@1000 of males and 3@1000 of females aged between 55 and 64 years to 50@1000 of males and 85@1000 of females aged 85 to 94 years. The average age for occurrence of cardiac insufficiency is 73.5 years; two thirds of patients are over 70 years. There are about 3.5 million consultations and 150,000 hospitalizations for cardiac insufficiency every year. The average length of stay is 11 days. There are more than 32,000 deaths annually from cardiac insufficiency. The costs linked to cardiac insufficiency represent more than 1% of total medical costs. Cardiac insufficiency is a major problem for public health, and it is more and more so. This must prompt us to treat our patients better, and to undertake more preventive measures.

Adult↗
PubMed2000

[Infectious endocarditis].

The incidence of infective endocarditis has not decreased over the last years. Infective endocarditis remains severe: the mortality rate during the initial hospital stay is 15%, and a surgical intervention is needed in 25% of the cases. Stricter application of prophylaxis guidelines and better diagnostic and therapeutic management should decrease the frequency and severity of infective endocarditis.

Antibiotic Prophylaxis↗
PubMed2000

Unjustified variations in patient management for acute myocardial infarction in the Rhône-Alpes region of France. PRIMA Group.

OBJECTIVES: To examine determinants of use of cardiac procedures after acute myocardial infarction and identify variation factors. METHODS: Observational prospective cohort study of 2,519 patients in 48 centers with a two-level logistic-regression analysis. RESULTS: Elderly patients were less likely to undergo pre- and inhospital thrombolysis (odds ratios, 0.71 and 0.64; 95% CI, 0.62-0.81 and 0.58-0.69, respectively). The elderly, females, and patients with heart failure on admission were less likely to undergo noninvasive tests (0.74, 0.62, and 0.51; 95% CI, 0.67-0.81, 0.46-0.83, and 0.38-0.68, respectively) and coronary angiography (0.38, 0.53, and 0.67; 95% CI, 0.34-0.42, 0.38-0.74, and 0.52-0.86, respectively) but not revascularization. Hospital factors were more difficult to interpret. CONCLUSIONS: Elderly, women, and heart failure patients underwent fewer cardiac procedures than lower-risk patients. Physicians should change their attitude toward these groups and use advanced procedures, bearing in mind the patients' needs rather than good procedural outcomes.

Age Factors↗
PubMed2000

A national survey of heart failure in French hospitals. The Myocardiopathy and Heart Failure Working Group of the French Society of Cardiology, the National College of General Hospital Cardiologists and the French Geriatrics Society.

Rationale The epidemiology of heart failure and patient management procedures may vary from one country to another. This study was designed to analyse the spectrum of patients hospitalized in France for heart failure. Patients and Methods A registry involving 120 departments (cardiology, general medicine and geriatrics) and 1058 patients.Results The patients' median age was 76 years, and the male/female ratio was 55/45. Echocardiography was performed in 77% of the cases: the left ventricular ejection fraction was <30% in 22%, between 30 and 40% in 25% and greater than 40% in 53%. Angiotensin-converting enzyme (ACE) inhibitors were prescribed to, respectively, 78% and 63% of patients with ejection fractions above and below 40%. Conclusion In France, patients hospitalized for heart failure tend to be old and are often women; about one in two have relatively preserved left ventricular systolic function. ACE inhibitor prescription seems to be more frequent than currently reported. This survey confirms the clear gap between the populations in clinical trials and those in routine clinical practice.

Aged↗
PubMed2000

Characteristics, management, and in-hospital mortality of acute myocardial infarction in the "real world" in France--data from a large unselected cohort of 2,519 consecutive patients in a French region.

OBJECTIVE: The prospective PRIMA study (Prise en charge de l'Infarctus du Myocarde Aigu; management of acute MI) sought to determine characteristics, management, and in-hospital mortality of myocardial infarction (MI), regardless of age and hospital facilities, in the "real world" in a region in France. METHODS AND RESULTS: Data were prospectively collected in all patients with MI admitted in all hospitals in three departments in the Rh ne-Alpes region between September 1, 1993 and January 31, 1995. 2,519 patients (68% men; mean +/- SD: 68 +/- 14 years) were included. Time from onset of symptoms to admission was < 6 h in 56% of the patients (median: 4 h 30 min). MI was non-Q wave in 12%. Among Q wave MI, location was anterior in 44%. At admission, Killip class was > 1 in 33%. The overall rate of thrombolysis was 36%. It was significantly higher in men than in women, in younger patients than in older patients, in lower Killip classes, in Q wave MI, and when the delay before initial medical intervention was < 6 hours. After age-adjustment, there was no difference between men and women for thrombolysis rate (odds ratio women/men: 0.92; p = 0.10). During the first 5 days, Killip class worsened in 17%. In-hospital mortality rate was 14%. Multivariate analysis identified age, anterior location, presence of Q waves, and higher Killip classes as significant predictors of in-hospital mortality. CONCLUSIONS: This large unselected cohort revealed that among patients with MI in a French region, there was a high proportion of elderly patients, a low rate of thrombolysis, and a high in-hospital mortality.

Age of Onset↗
PubMed1999

[Primary prevention of atherosclerosis].

Primary prevention consists of acts that decrease the level of risk factors in order to avoid the occurrence of atherosclerosis or to limit its consequences. Even incomplete control of risk factors leads to substantial decrease in the overall risk. Such results should encourage individuals and physicians to continue their efforts. First, the absolute risk for an individual should be evaluated on a risk scale. Then, the various factors to be targeted are smoking, hypertension, plasma lipid anomalies, lack of balanced diet, overweight, sedentary life style and diabetes. Compliance to recommended changes in life style varies greatly, which probably explains why the observed benefit is less than expected. Prevention should be an integral part of daily practice, and the motivation of both physicians and individuals must be constantly supported.

Arteriosclerosis↗
PubMed1999

A critical appraisal of the quality of the management of infective endocarditis.

OBJECTIVES: The purpose of this study was to assess the quality of the management of infective endocarditis. BACKGROUND: Although many guidelines on the management of infective endocarditis exist, the quality of this management has not been evaluated. METHODS: We collected data on all patients (116) hospitalized with infective endocarditis over 1 year in all hospitals in the Rhône-Alpes region (France). RESULTS: Prophylactic antibiotics were not given before infective endocarditis to 8/11 cardiac patients at risk and who underwent an at risk procedure. Among the 55 cardiac patients at risk and with fever and who consulted a physician, blood cultures were not performed before antibiotic therapy was initiated for 32 patients. In-hospital antibiotic therapy was incorrect for 23 patients. The portal of entry was not treated for 16/61 patients with an accessible portal of entry. Among the 19 patients who had severe heart failure or fever persisting more than 2 weeks in spite of antibiotic therapy and who could have undergone early surgery, surgery was delayed for five, and not performed for three. Overall, the average score was 15/20. CONCLUSIONS: More information on the management of infective endocarditis should be widely disseminated to the physicians' and the dentists' communities and to the patients at risk.

Aged↗
PubMed1998

Antibiotic prophylaxis for permanent pacemaker implantation: a meta-analysis.

BACKGROUND: Infection remains a serious complication after permanent pacemaker implantation. Antibiotic prophylaxis is frequently prescribed at the time of insertion to reduce its incidence, although results of well-designed, controlled studies are lacking. METHODS AND RESULTS: We performed a meta-analysis of all available randomized trials to evaluate the effectiveness of antibiotic prophylaxis to reduce infection rates after permanent pacemaker implantation. Reports of trials were identified through a Medline, Embase, Current Contents, and an extensive bibliography search. Trials that met the following criteria were included: (1) prospective, randomized, controlled, open or blind trials; (2) patients assigned to a systemic antibiotic group or a control group; (3) end point events related to any infection after pacemaker implantation: wound infection, septicemia, pocket abscess, purulent secretion, right infective endocarditis, inflammatory signs, a positive culture, septic pulmonary embolism, or repeat operation for an infective complication. Seven trials met the inclusion criteria. They included 2023 patients with established permanent pacemaker implantation (new implants or replacements). The incidence of end point events in control groups ranged from 0% to 12%. The meta-analysis suggested a consistent protective effect of antibiotic pretreatment (P=.0046; common odds ratio: 0.256, 95% confidence interval: 0.10 to 0.656). CONCLUSIONS: Results of the present meta-analysis suggest that systemic antibiotic prophylaxis significantly reduces the incidence of potentially serious infective complications after permanent pacemaker implantation. They support the use of prophylactic antibiotics at the time of pacemaker insertion to prevent short-term pocket infection, skin erosion or septicemia.

Adult↗