Olivier Saint-Jean

Clinical usefulness in geriatric patients of combining CHADS2 and HEMORR2HAGES scores to guide antithrombotic prophylaxis in atrial fibrillation.

Background and aims: Two scores exist to assess the benefits and risks of antithrombotic therapy in patients with atrial fibrillation: CHADS2 [for Congestive heart failure, Hypertension, Age over 75, Diabetes mellitus; and 2 points for a history of Stroke] and HEMORR2HAGES [for Hepatic or renal failure, Ethanol abuse, Malignancy, Older (age over 75), Reduced platelet count or function, 2 points for Rebleeding risk Hypertension (uncontrolled), Anemia, Genetic factors, Excessive fall risk (including neurodegenerative and psychiatric disorders) and history of Stroke]. The potential value of using both scores routinely was studied in order to guide the choice of antithrombotic therapy for geriatric patients. Methods: Retrospective calculation of CHADS2 and HEMORR2HAGES scores and discharge treatment were collected for all patients with atrial fibrillation during a six-month period. All files were analysed when there were differences between therapeutic choices and the results of analysis of combining the two scores. Results: 83 patients were identified. Their mean age was 89.2±4.9 years and 30% of them were on oral anticoagulants on discharge. Usual prescription habits of oral anticoagulants correlated strongly with each of the scores and with the difference between the two scores. The clinical usefulness of using the two scores seemed poor since they indicated that two-thirds of the patients had a similar risk of hemorrhagic and ischemic events. Conclusions: Based on this preliminary study, the CHADS2 and HEMORR2HAGES scores are associated with the prescription of oral anticoagulants, but their routine use may not significantly change the choice of antithrombotic therapy for patients with atrial fibrillation.

French Multicenter Evaluation of the Appropriateness of Admission to the Emergency Department of the Over-80s.

BackgroundPersons over 80 represents 40% of patients in French emergency services. We assessed the appropriateness of these admissions and sought to identify risk factors for inappropriate hospital stays.MethodsThe appropriateness of admission was assessed in a prospective, cross-sectional, multicenter study in eight hospitals in France by means of the Appropriateness Evaluation Protocol (French version, AEPf) during two non-consecutive periods of four weeks in 2010. We analyzed admission of patients aged 80 and over who were admitted to the hospital after a stay in the emergency department of the same hospital. Demographics and morbidity factors were recorded as were administrative hospitalization data to identify risk factors associated with inappropriate admissions. We also evaluated the economic impact of inappropriate admissions. For cost analysis, all variables were obtained from anonymized hospital reports of a diagnosis-related group system used for funding of the hospitals by health insurance.ResultsDuring two different periods, 1577 patients were included. 139 (8.8%) hospital admissions were inappropriate according to explicit criteria of the AEPf, but 18 of these (1.1%) were in fact considered appropriate by the physician responsible for the admission, leading to 121 (7.7%) inappropriate admissions. Multivariate logistic regression showed that patients with heart disease were less often subject to inappropriate admission (odds ratio OR= 0.36 [0.23; 0.56], p < 0.001), as also were patients who usually lived in a nursing home (OR = 0.53 [0.30; 0.87], p = 0.018) and patients with higher Acute Physiology Scores (OR = 0.97 [0.95; 0.99], p < 0.001). Inappropriate admission increased when patients had a syndrome as the main diagnosis (OR = 1.81 [1.81; 2.83], p = 0.010). By contrast, cognitive functions, gait and balance disturbance or falls, behavioral disorders and method of transport to the emergency department did not change the probability of inappropriateness. The median cost of the hospital stay of an older patient was 3 606.5 [2 498.1; 4 994.2] euros for inappropriate admissions.ConclusionInappropriate emergency admissions of older patients were infrequent. None of the geriatric syndromes were linked with the phenomenon and principle causes were severity of illness, mention of a cardiac disease, unclear pattern of consultation and institutionalized way of life.

Sujets âgés atteints de cancer en France : quel recours à l’hospitalisation en 2012 ?

INTRODUCTION French national cancer plans were rolled out oncogeriatric coordination units in France in particular to enable all elderly people with cancer in each region to benefit from a specific care management. METHODS The national hospital discharge database was analyzed in order to analyze hospitalizations related to cancer care in ≥75 years patients for year 2012. RESULTS A total of 358,721 patients with 1,492,935 hospitalizations were recorded, respectively with chemotherapy (32.4%), radiotherapy (23.0%), surgery (10.6%), palliative care (3.9%), or other care (30.9%). Hospital activity was distributed in hospitals (36.3%), clinics (23.4%), academic hospitals (20.9%), cancer centers (11.8%). Their respective share varied according to care. Total activity volume and number of health care facilities involved were highly variable in the different regions. CONCLUSION These data would permit development of a national oncogeriatric policy through the action of regional oncogeriatric coordination units. These units should prioritize training actions and good practice guidelines dissemination in health care institutions with a high activity volume in this domain.

Association between borderline dysnatremia and mortality insight into a new data mining approach

BackgroundEven small variations of serum sodium concentration may be associated with mortality. Our objective was to confirm the impact of borderline dysnatremia for patients admitted to hospital on in-hospital mortality using real life care data from our electronic health record (EHR) and a phenome-wide association analysis (PheWAS).MethodsRetrospective observational study based on patient data admitted to Hôpital Européen George Pompidou, between 01/01/2008 and 31/06/2014; including 45,834 patients with serum sodium determinations on admission. We analyzed the association between dysnatremia and in-hospital mortality, using a multivariate logistic regression model to adjust for classical potential confounders. We performed a PheWAS to identify new potential confounders.ResultsHyponatremia and hypernatremia were recorded for 12.0% and 1.0% of hospital stays, respectively. Adjusted odds ratios (ORa) for severe, moderate and borderline hyponatremia were 3.44 (95% CI, 2.41–4.86), 2.48 (95% CI, 1.96–3.13) and 1.98 (95% CI, 1.73–2.28), respectively. ORa for severe, moderate and borderline hypernatremia were 4.07 (95% CI, 2.92–5.62), 4.42 (95% CI, 2.04–9.20) and 3.72 (95% CI, 1.53–8.45), respectively. Borderline hyponatremia (ORa = 1.57 95% CI, 1.35–1.81) and borderline hypernatremia (ORa = 3.47 95% CI, 2.43–4.90) were still associated with in-hospital mortality after adjustment for classical and new confounding factors identified through the PheWAS analysis.ConclusionBorderline dysnatremia on admission are independently associated with a higher risk of in-hospital mortality. By using medical data automatically collected in EHR and a new data mining approach, we identified new potential confounding factors that were highly associated with both mortality and dysnatremia.