A. Gabet

National trends in rate of patients hospitalized for heart failure and heart failure mortality in France, 2000–2012

The objectives of this study were to describe annual trends in patients hospitalized for heart failure (HF) and HF‐associated mortality rates in France between 2000 and 2012.

Acute coronary syndrome in women: rising hospitalizations in middle-aged French women, 2004–14

Aims We aimed to analyse trends in annual incidence of hospitalized acute coronary syndrome (ACS) in France from 2004 to 2014. Methods and results Primary diagnosis of ACS and subtypes on admissions were selected in national and exhaustive French Hospitalization Database from 2004 to 2014. Age-standardized rates were computed using standardization on the census of the 2010 European population and mean annual percent changes were estimated by using Poisson regression model. In 2014, 113 407 patients, 36 480 women (32.2%) and 76 927 men (67.8%) were hospitalized for ACS. Among women, the proportion aged under 65 years was 25.2% (n = 9206) and there was 34.4% of STEMI, 18.2% of NSTEMI and 47.4% of UA. From 2004 to 2014, the rates of age-standardized admissions for ACS in women less than 65 years old increased by 6.3%.This rise in ACS was driven by significant increases in STEMI (+21.7%) and NSTEMI (+53.7%). The largest increase in STEMI mean annual percent change was observed among women aged 45–54 years old (+3.6%/per year). After 65 years of age, significant decreases in all ACS types were observed. Conclusion This nationwide study showed substantial rising trends in STEMI annual incidence, especially among younger women. This increase could be attributed to increase in smoking and obesity. Efforts to strengthen primary prevention of CVD in younger women is needed as the main risk factors are modifiable, and as there is a growing evidence of higher short-term mortality of CHD in women.

National Trends in Patients Hospitalized for Stroke and Stroke Mortality in France, 2008 to 2014

Background and Purpose— Stroke is the leading cause of death in women and the third leading cause in men in France. In young adults (ie, <65 years old), an increase in the incidence of ischemic stroke was observed at a local scale between 1985 and 2011. After the implementation of the 2010 to 2014 National Stroke Action Plan, this study investigates national trends in patients hospitalized by stroke subtypes, in-hospital mortality, and stroke mortality between 2008 and 2014. Methods— Hospitalization data were extracted from the French national hospital discharge databases and mortality data from the French national medical causes of death database. Time trends were tested using a Poisson regression model. Results— From 2008 to 2014, the age-standardized rates of patients hospitalized for ischemic stroke increased by 14.3% in patients <65 years old and decreased by 1.5% in those aged ≥65 years. The rate of patients hospitalized for hemorrhagic stroke was stable (+2.0%), irrespective of age and sex. The proportion of patients hospitalized in stroke units substantially increased. In-hospital mortality decreased by 17.1% in patients with ischemic stroke. From 2008 to 2013, stroke mortality decreased, except for women between 45 and 64 years old and for people aged ≥85 years. Conclusions— An increase in cardiovascular risk factors and improved stroke management may explain the increase in the rates of patients hospitalized for ischemic stroke. The decrease observed for in-hospital stroke mortality may be because of recent improvements in acute-phase management.

Regional disparities in acute and post-acute care of stroke patients in France, 2015

OBJECTIVE The aim of this study was to assess regional variations of the hospital management of stroke patients during acute and post-acute phases in France in 2015. MATERIAL AND METHODS Hospitalized patients coded with stroke as their main diagnosis or, if hospitalized in several different wards, any main ward diagnosis were identified in the 2015 French national hospital discharge database for acute care. Rates of hospitalization in stroke units (SUs) were assessed at a national level and in all metropolitan and overseas regions. All stroke survivors discharged at the end of the acute phase were subsequently identified in the national database for post-acute rehabilitation hospitalization (PARH) within 3 months. RESULTS In the acute phase, half the stroke patients hospitalized for intracerebral hemorrhage, cerebral infarction or unspecified stroke were admitted to SUs. However, there were variations across metropolitan regions (from 30% to 69%) and in overseas regions (from 1% to 59%); these rates correlated with regional ratios of SU beds/100,000 inhabitants. There were also regional differences in PARH rates-in hemiplegic stroke patients, 62% were admitted for PARH (range: 58% to 67%) in metropolitan regions and, overseas, from 8% to 67%-as well as geographical discrepancies in PARH rates to specialized rehabilitation units. Hospitalization rates of hemiplegic stroke patients in neurological rehabilitation centers were 30% for the whole country, but ranged from 23% to 36% in metropolitan regions and from 2% to 45% in overseas regions. CONCLUSION This study focused on hospital-based management of stroke patients. In spite of the creation of new SUs over the past decade in France, there are persistent regional differences in the number of SU beds/100,000 inhabitants and, consequently, in the rate of stroke patients managed in SUs. However, rates continue to improve with the creation of new SUs and the expansion of existing ones. Regional variations were also noted for post-acute hospitalization rates and PARH beds/places.

Admission in Neurorehabilitation and Association with Functional Outcomes after Stroke in France: A Nation-Wide Study, 2010-2014

GOAL We studied time trends of admission in neurological rehabilitation units (NRU) among patients hospitalised for stroke from 2010 to 2014 and compared prognostic factors of functional gain, home return and inpatient survival. METHODS Patients hospitalized for Stroke from 2010 to 2014 were selected from the French national hospital databases. Admission in rehabilitation was searched till 3 months. Predictive factors of functional gain, home return, in-patient survival, and the corresponding trends were studied using logistic regression. RESULTS In 2014, global rehabilitation rate was 36.3% with 15.8 discharged in a NRU. The rate of patients managed in NRU rose between 2010 and 2014. An increase in the proportion of home return (+4%) and inpatient survival rate (+7%) were observed between 2010 and 2014. Almost 40% of patients with severe functional deficits benefited of a partial or complete recovery after their rehabilitation stay. NRU admission was associated with higher probability of functional gain (OR [odds ratio] =1.76 [confidence interval {CI} 95% 1.67-1.85]), home return (OR = 1.38 [CI 95% 1.29-1.47]) and inpatient survival (OR = 3.15 [CI 95% 2.83-3.52]). CONCLUSIONS A greater proportion of patients were admitted in NRU along with an increase of home return and in-patient survival, but too many patients remained excluded.

The 2015 and 2016 terrorist attacks in France: was there a short-term impact on hospitalizations for cardiovascular disease?

Background The terrorist attacks in Paris and Nice in 2015 and 2016 generated widespread emotional stress in France. Given that acute emotional stress is a well-known trigger for cardiovascular disease, we investigated whether these attacks had any short-term impact on hospitalizations for acute cardiovascular disease in France. Methods Annual hospital discharge data from 2009 to 2016 were extracted from the French Hospital Discharge Database. All hospitalizations with a primary diagnosis of acute coronary syndrome, heart failure, or stroke were selected. Generalized additive Poisson models were used to differentiate “unusual” variations in daily hospitalization numbers in the 15 days following the attacks from the expected background hospitalization rate. Results The average daily number of hospitalizations was 396.4 for acute coronary syndrome, 598.6 for heart failure, and 334.6 for stroke. The daily mean number of hospitalizations for heart failure and stroke was higher in the 15 days following each attack compared with the reference periods. However, multivariate analysis showed no significant variation in the risk of hospitalization in the days following the attacks. Interpretation Watching events unfold on television, no matter how dramatic, was not a sufficiently potent trigger for cardiovascular disease, although it may have led to an increase in hospitalizations for stress or anxiety. The 2015 and 2016 terrorist attacks do not seem to have had any measurable short-term impact on hospitalizations for cardiovascular disease either in the Paris and Nice regions or in the rest of France.

Time trends in admissions in follow-up care and rehabilitation units after stroke in France, 2010–2014

Background In France, one objective of the “2010–2014 National Stroke Action Plan” was to develop follow-up care and rehabilitation (SSR) facilities in order to insure home return in the best conditions. Purpose The objective of this study was to describe recent temporal trends in admissions in SSR facilities after hospitalization for stroke from 2010 to 2014. Methods Patients hospitalized for cerebral infarction (CI) or hemorrhagic stroke (HS) during the nine first months of each year from 2010 to 2014 were selected from exhaustive national French hospitalization databases. Among patients alive at the end of the index hospitalization, admissions in SSR facilities were searched till 3 months. Time trends were studied using quasi-Poisson regression model. Prognostic factors of admission in SSR services were identified by logistic regression model. Results During the nine first months of 2014, 68,074 patients were hospitalized for stroke and did not die during their hospitalization. Among them, 24,690 (36%) were admitted in SSR units in the 3 months following the end of the index hospitalization. HS and presence of a paralysis were strongly associated with SSR admission. Male sex and previous stay in stroke unit were positively associated with SSR admission among patients aged under 65 and negatively associated among those aged 65 or over. Between 2010 and 2014, a significant increase in SSR admission rate was only observed among stroke patients aged under 35 years or over 75 years. The proportion of neurological rehabilitation increased substantially and constituted 40% of SSR admissions in 2014. Functional dependence score at admission and its evolution during SSR hospitalization remained steady over the study period. Conclusion SSR admission rates after stroke remained low and did not rose during the study period except in the elderly. However, favorable trends in admissions in SSR units specialized in neurological rehabilitation were observed.

Time trends in hospital admissions and mortality due to abdominal aortic aneurysms in France, 2002–2013

Background Abdominal aortic aneurysms (AAA) are serious disease with a high fatality rate but recent epidemiologic data in France are lacking. Purpose Our objective was to estimate, in France, the hospitalization, in hospital mortality and mortality rates due to AAA and to analyze their trends over time. Methods Hospitalization data were extracted from the hospital discharge summaries in the national database between 2002 and 2013. The analysis covered all patients hospitalized for AAA as a principal diagnosis. During the same period, all death certificates mentioning AAA as an initial cause of death were included in the study. Crude and standardized rates were calculated according to age and sex. Poisson regression was used to analyze the average annual percent change. Results In 2013, there were 8 853 patients hospitalized for AAA in France (7 986 unruptured and 867 ruptured). Between 2002 and 2013, the rate of patients hospitalized for unruptured AAA decreased slightly in men (−5.0%) but increased in women (+5.2%). By contrast, the rate of patients hospitalized for ruptured AAA has decreased by more than 20% in men and women. The proportion of endovascular treatment of unruptured AAA rose from less than 10% in 2005 to 35% in women and 40% in men in 2013. In 2013, 939 deaths from AAA were recorded. Mortality for this disease declined significantly from 2002 to 2013 in men and women. Conclusion The unfavorable epidemiological trends in women and important evolution of the management of AAA call for an epidemiological surveillance of this disease.

Letter by Gabet et al Regarding Article, “Age-Specific Trends in Incidence, Mortality, and Comorbidities of Heart Failure in Denmark, 1995 to 2012”

With great interest, we have read the article by Christiansen et al1 describing Danish age-specific trends in heart failure incidence and mortality. However, the authors do not mention the results of a French nationwide study carried out on exhaustive databases of hospitalization. In this study, age-specific trends analyses between 2000 and 2012, including inpatients …

National trends in admission for cardiac rehabilitation after a myocardial infarction in France from 2010 to 2014

BACKGROUND Follow-up care and rehabilitation services [soins de suite et réadaptation (SSR)], especially cardiac rehabilitation (CR), constitute a key stage for patients who have had an acute myocardial infarction (AMI). AIMS To study admission to SSR, especially for CR, among patients hospitalized for AMI in France in 2014, and its temporal trend between 2010 and 2014. METHODS We used the French National Hospital Database to select patients hospitalized with a main diagnosis of AMI (identified by ICD-10 codes I21 to I23) in the first semester of each year from 2010 to 2014. We then searched for rehabilitation admission in the 6 months after the index hospitalization. We calculated age-standardized rates of admission for CR and for other rehabilitation purposes. The average annual percentage change in admission rates was analysed by Poisson regression. RESULTS In 2014, among the 29,424 patients hospitalized for an AMI in the first 6 months of the year, 10,873 (36.9%) were subsequently admitted to SSR units. More specifically, the age-standardized rate of patients hospitalized in CR units reached 28.4% (n=8380), and was greater among men (29.6%, n=6707) than among women (24.9%, n=1673). Between 2010 and 2014, rates of admission for CR increased by 5.0% per year in men and 6.6% per year in women. We found a great increase in ambulatory CR management, which accounted for half of the admissions for CR in 2014. CONCLUSIONS Favourable trends in rates of admission for CR were reported in both sexes and at all ages, except the oldest. The increase in ambulatory management contributed to these changes. Despite these trends, rates of admission for CR after AMI remain low.