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

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

Aim of the study: Describe general practitioner's practice in optimizing heart failure treatment after hospital discharge.

Patients and method: 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.

Results: 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.

Conclusion: 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.