Evaluation of the Program to Help Return Home Patients Hospitalized for Heart Failure, From Paris Saint-Joseph Hospital
Evaluation of the Program to Help Return Home Patients Hospitalized for Heart Failure, From Paris Saint-Joseph Hospital
The prevalence of heart failure is very high worldwide is between 1 and 2% in developed
 countries.

 The French Federation of Cardiology estimates that a million people are affected in France.
 Each year in France, there are nearly 70,000 deaths linked to heart failure, and more than
 150,000 hospitalizations with an average cumulative duration per year of 12.7 days, figures
 which show the extent of the phenomenon. Heart failure is therefore a common pathology, which
 constitutes an important public health issue. It requires rigorous monitoring and early
 adaptation of treatments to avoid repeated hospitalizations. Studies show that following
 hospitalization for heart failure, all-cause re-hospitalization rates rise to 18% within 30
 days. In 2019, the rate of re-hospitalization at 1 year is 30%, half of which in the
 following 3 months. The prognosis is grim with 20 to 30% of deaths within the year.

 The European Society of Cardiology recommends that the patient be integrated into a care path
 coordinated by the general practitioner; and a consultation with his general practitioner in
 the week after hospitalization and his cardiologist within two weeks. The CPAM (Caisse
 Primaire d'Assurance Maladie) has set up since 2013 the PRADO-IC program (Program for Return
 to Home Hospital for Heart Failure). This program must be in place before discharge from
 hospital. A health insurance advisor comes to meet the patient, declared eligible for PRADO
 by the hospital medical team, to present the offer and collect his approval before discharge.
 He then contacts the attending physician and organizes his return home. A follow-up book is
 given to the patient to allow better transmission of information between town and hospital.

 A specially trained nurse visits the patient's home every week. The duration of PRADO support
 varies according to the NYHA stage of severity. It provides therapeutic education with
 reinforcement of hygieno-dietetic rules, warning signs, checks compliance with treatments and
 the necessary biological monitoring and must alert the attending physician in the event of
 aggravation.

 The objectives of this program are: to preserve the quality of life and the autonomy of
 patients, to support the reduction of the length of stay in hospital, to strengthen the
 quality of care in town around the attending physician, improve the efficiency of recourse to
 hospitalization by reserving the heaviest structures for the patients who need them most.
The prevalence of heart failure is very high worldwide: according to the European Society of
 Cardiology, it is between 1 and 2% in developed countries.

 The French Federation of Cardiology estimates that a million people are affected in France.
 This prevalence increases sharply with age, reaching 15% of people aged 85 and over.

 Each year in France, there are nearly 70,000 deaths linked to heart failure, and more than
 150,000 hospitalizations with an average cumulative duration per year of 12.7 days, figures
 which show the extent of the phenomenon. In addition, the aging of the population and the
 explosion of cardiovascular risk factors suggest that the impact of heart failure will be
 greater in the future.

 Heart failure is therefore a common pathology, which constitutes an important public health
 issue. It requires rigorous monitoring and early adaptation of treatments to avoid repeated
 hospitalizations. Studies show that following hospitalization for heart failure, all-cause
 re-hospitalization rates rise to 18% within 30 days. According to a report from the Caisse
 Primaire d'Assurance Maladie (CPAM) in 2019, the rate of re-hospitalization at 1 year is 30%,
 half of which in the following 3 months. The prognosis is grim with 20 to 30% of deaths
 within the year.

 The European Society of Cardiology recommends that the patient be integrated into a care path
 coordinated by the general practitioner; and a consultation with his general practitioner in
 the week after hospitalization and his cardiologist within two weeks. But general
 practitioners deplore a lack of coordination between city and hospital with difficulties in
 taking care of their patient following hospitalization. According to the CPAM report, only
 30% of re-hospitalized patients had contact with a cardiologist before their readmission, and
 15% of patients had no contact with the health care system within 2 months of followed their
 hospitalization.

 It is in this need to improve monitoring that the CPAM has set up since 2013 the PRADO-IC
 program (Support Program for Return to Home Hospital for Heart Failure). This program must be
 in place before discharge from hospital. A health insurance advisor comes to meet the
 patient, declared eligible for PRADO by the hospital medical team, to present the offer and
 collect his approval before discharge. He then contacts the attending physician and organizes
 his return home. A follow-up book is given to the patient to allow better transmission of
 information between town and hospital.

 A specially trained nurse (internet training) visits the patient's home every week. The
 duration of PRADO support varies according to the NYHA stage of severity: a patient in NYHA
 stage I or II benefits from home support for a period of 2 months, and 6 months for NYHA
 stages III and IV. It should make it possible to monitor the constants: blood pressure,
 pulse, and weight. It provides therapeutic education with reinforcement of hygieno-dietetic
 rules (low sodium diet), warning signs (orthopnea, cough, dyspnea), checks compliance with
 treatments and the necessary biological monitoring and must alert the attending physician in
 the event of aggravation.

 The objectives of this program are: to preserve the quality of life and the autonomy of
 patients, to support the reduction of the length of stay in hospital, to strengthen the
 quality of care in town around the attending physician, improve the efficiency of recourse to
 hospitalization by reserving the heaviest structures for the patients who need them most.

 The main objective of this study is therefore to assess the impact of the PRADO program on
 re-hospitalization at 1 year, at Paris Saint-Joseph hospital for heart failure.
Inclusion Criteria:

 Patients included in PRADO

 -  Patient whose age is ≥ 18 years

 -  Patient hospitalized for global heart failure or left ventricular failure in the
 Cardiology department of the GHPSJ between January 2016 and September 2018

 -  Patients included in the PRADO program Patients not included in PRADO

 -  Patient whose age is ≥ 18 years

 -  Patient hospitalized for global heart failure or left ventricular failure in the
 Cardiology department of the GHPSJ between January 2016 and September 2018

 -  Patients not included in the PRADO program

 Exclusion Criteria:

 -  Patient under guardianship or guardianship

 -  Patient living in EHPAD

 -  Patient transferred to another establishment on discharge from hospital (surgery,
 follow-up care, EPHAD, etc.)

 -  Patient who died during hospitalization

 -  Patient objecting to the use of their data