1
|
Javaud N, Altar A, Fain O, Reuter PG, Desmaizieres M, Petrovic T, Ghazali A, Durand-Zaleski I, Bouillet L, Vicaut E, Launay D, Martin L, Floccard B, Gompel A, Sobel A, Boccon-Gibod I, Kanny G, Lapostolle F, Adnet F. Hereditary angioedema, emergency management of attacks by a call center. Eur J Intern Med 2019; 67:42-46. [PMID: 31109849 DOI: 10.1016/j.ejim.2019.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 03/17/2019] [Accepted: 05/13/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Hereditary angiœdema (HAE) is a rare autosomal dominant disease characterized by recurrent, unpredictable, potentially life-threatening swelling. Objective is to assess the management of the acute HAE attacks in the real life setting through a call center in France. METHODS A pre-specified ancillary study of SOS-HAE, a cluster-randomized prospective multicenter trial, was conducted. HAE patients were recruited from 8 participating reference centers. The outcome of interest was the rate of hospitalization. RESULTS onerhundred patients were included. The median (quartile) age was 38 (29-53) years, and 66 (66%) were female. Eighty (80%) patients had HAE type I, 8 (8%) had HAE type II and 12 (12%) patients had FXII-HAE. Fifty-one (51%) patients had experienced at least one time the call center during the follow-up. Nine over 166 (5%) attacks for 9 different patients resulted in hospital admission to the hospital (in the short-stay unit, ie, <24 h) during the follow-up period. During 2 years, there were 166 calls to call center for 166 attacks. All attacks were treated at home after call center contact. CONCLUSIONS Use of emergency departments and hospitalizations are reduced by the use of a coordinated national call center in HAE after therapeutic education program that promoted self-administration of specific treatment and use of call to call center. TRIAL REGISTRATION clinicalTrials.gov identifier: NCT01679912.
Collapse
Affiliation(s)
- Nicolas Javaud
- AP-HP, Urgences, Centre de référence sur les angiœdèmes à kinines, Hôpital Louis Mourier, Université Paris 7, 92700 Colombes, France; AP-HP, Urgences - Samu 93, Hôpital Avicenne, Université Paris 13, Inserm U942, 93000 Bobigny, France.
| | - Adrien Altar
- AP-HP, Urgences, Centre de référence sur les angiœdèmes à kinines, Hôpital Louis Mourier, Université Paris 7, 92700 Colombes, France
| | - Olivier Fain
- AP-HP, Médecine Interne, DHUi2B, Centre de Référence associé sur les angiœdèmes à kinines (CRéAk), Hôpital Saint-Antoine, Université Paris 6, 75 012 Paris, France.
| | - Paul-Georges Reuter
- AP-HP, Urgences - Samu 93, Hôpital Avicenne, Université Paris 13, Inserm U942, 93000 Bobigny, France.
| | - Michel Desmaizieres
- AP-HP, Urgences - Samu 93, Hôpital Avicenne, Université Paris 13, Inserm U942, 93000 Bobigny, France.
| | - Tomislav Petrovic
- AP-HP, Urgences - Samu 93, Hôpital Avicenne, Université Paris 13, Inserm U942, 93000 Bobigny, France.
| | - Aiham Ghazali
- AP-HP, Urgences, Hôpital Bichat, Université Paris 7, 75018 Paris, France..
| | - Isabelle Durand-Zaleski
- AP-HP, URCEco Ile de France, Hôpital de l'Hôtel-Dieu, Université Paris 12, 75 004 Paris, France.
| | - Laurence Bouillet
- Médecine Interne, Centre de Référence sur les angiœdèmes à kinines (CRéAk), CHU de Grenoble, 38043 Grenoble, France.
| | - Eric Vicaut
- AP-HP, Unité de Recherche Clinique, Hôpital Fernand Widal, Paris, France.
| | - David Launay
- Université de Lille, CHRU de Lille, Médecine Interne, Centre de Référence sur les angiœdèmes à kinines (CRéAk), Hôpital Claude Huriez, 59037 Lille Cedex, France.
| | - Ludovic Martin
- Dermatologie, Centre de Référence sur les angiœdèmes à kinines (CRéAk), Université d'Angers, CHU d'Angers, 49 933 Angers, cedex, France.
| | - Bernard Floccard
- Hospices Civils de Lyon, Réanimation, Centre de Référence sur les angiœdèmes à kinines (CRéAk), CHU Edouard Herriot, 69 437 Lyon, Cedex, France.
| | - Anne Gompel
- Université de Paris-Descartes, AP-HP, HUPC, Unité de Gynécologie Endocrinienne, Hôpital Port Royal, 75001 Paris, France
| | - Alain Sobel
- AP-HP, Hôpital Hôtel Dieu, Université Paris 5, 75004 Paris, France.
| | - Isabelle Boccon-Gibod
- Médecine Interne, Centre de Référence sur les angiœdèmes à kinines (CRéAk), CHU de Grenoble, 38043 Grenoble, France.
| | - Gisele Kanny
- Médecine Interne, Centre de Référence sur les angiœdèmes à kinines (CRéAk), CHU de Nancy, 54 035 Nancy, France.
| | - Frederic Lapostolle
- AP-HP, Urgences - Samu 93, Hôpital Avicenne, Université Paris 13, Inserm U942, 93000 Bobigny, France.
| | - Frederic Adnet
- AP-HP, Urgences - Samu 93, Hôpital Avicenne, Université Paris 13, Inserm U942, 93000 Bobigny, France.
| |
Collapse
|
3
|
Specialist Advice Support for Management of Severe Hereditary Angioedema Attacks: A Multicenter Cluster-Randomized Controlled Trial. Ann Emerg Med 2018; 72:194-203.e1. [PMID: 29503044 DOI: 10.1016/j.annemergmed.2018.01.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 01/08/2018] [Accepted: 01/23/2018] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE Hereditary angioedema is a rare disease associated with unpredictable, recurrent attacks of potentially life-threatening edema. Management of severe attacks is currently suboptimal because emergency medical teams are often unaware of new specific treatments. The objective of this trial is to test whether a dedicated national telephone care-management strategy would reduce resource use during severe hereditary angioedema attacks. METHODS We conducted a cluster-randomized multicenter prospective trial of patients with a documented diagnosis of hereditary angioedema (type I, II or FXII hereditary angioedema). Participants were enrolled between March 2013 and June 2014 at 8 participating reference centers. The randomized units were the reference centers (clusters). Patients in the intervention arm were given a national free telephone number to call in the event of a severe attack. Emergency physicians in the SOS-hereditary angiœdema (SOS-HAE) call center were trained to advise or prescribe specific treatments. The primary outcome was number of admissions for angioedema attacks. Economic evaluation was also performed. RESULTS We included 100 patients in the SOS-HAE group and 100 in the control group. During the 2 years, there were 2,368 hereditary angioedema attacks among 169 patients (85%). Mean number of hospital admissions per patient in the 2-year period was significantly greater in the usual-practice group (mean 0.16 [range 0 to 2] versus 0.03 [range 0 to 1]); patient risk difference was significant: -0.13 (95% confidence interval -0.22 to -0.04; P=.02). Probabilistic sensitivity graphic analysis indicated a trend toward increased quality-adjusted life-years in the SOS-HAE group. CONCLUSION A national dedicated call center for management of severe hereditary angioedema attacks is associated with a decrease in hospital admissions and may be cost-effective if facilities and staff are available to deliver the intervention alongside existing services.
Collapse
|
4
|
Javaud N, Fain O, Adnet F. Icatibant for ACE-inhibitor angioedema, an opportunity to treat the patients? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2017; 5:1803. [PMID: 29122163 DOI: 10.1016/j.jaip.2017.07.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/25/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Nicolas Javaud
- AP-HP, Urgences, Samu 93, Hôpital Avicenne, Université Paris 13, Bobigny, France; AP-HP, Urgences, Centre de référence sur les angiœdèmes à kinines (CRéAk), Hôpital Louis Mourier, Université Paris 7, Colombes, France.
| | - Olivier Fain
- AP-HP, Médecine Interne, DHUi2B, Centre de Référence associé sur les angiœdèmes à kinines (CRéAk), Hôpital Saint-Antoine, Université Paris 6, Paris, France
| | - Frédéric Adnet
- AP-HP, Urgences, Samu 93, Hôpital Avicenne, Université Paris 13, Bobigny, France
| |
Collapse
|