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Nevoret C, Tran Y, Guendouz S, Lavenu A, Katsahian S, Damy T, Tropeano AI. Cardiovascular disease healthcare trajectories: descriptions, similarities, mortality rates of heart failure in France. ESC Heart Fail 2024. [PMID: 38509817 DOI: 10.1002/ehf2.14753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/31/2024] [Accepted: 02/18/2024] [Indexed: 03/22/2024] Open
Abstract
AIMS The primary objectives of this study were to analyse the nationwide healthcare trajectories of heart failure (HF) patients in France, 2 years after their first hospitalization, and to measure sequence similarities. Secondary objectives were to identify the association between trajectories and the risk of mortality. METHODS AND RESULTS A retrospective, observational study was conducted using data extracted from the Echantillon Généraliste des Bénéficiaires database, covering the period from 1 January 2008 to 31 December 2018. Follow-up concluded upon death or at the end of the study. We developed a methodology specific to healthcare data by extracting frequent healthcare trajectories and measuring their similarity for use in a survival machine learning analysis. In total, 11 488 HF patients were included and followed up for an average of 2.9 ± 1.3 years. The mean age of the patients was 78.0 ± 13.2 years. The first-year mortality rate was 31.7% and increased to 78.8% at 5 years. Fifty per cent of patients experienced re-hospitalization for reasons related to cardiovascular diseases. We identified 1707 hospitalization sequences, and 21 sequences were associated with survival, while 15 sequences were linked to mortality. In all our models, age and gender emerged as the most significant predictors of mortality (permutation feature importance: 0.099 ± 0.00078 and 0.0087 ± 0.00018, respectively; weights could be interpreted in relative terms). Specifically, the age at initial hospitalization for HF was positively associated with mortality. Gender (male: 49.5%) was associated with poorer prognoses. Healthcare trajectories, including non-surgical device treatments, valve replacements, and atrial fibrillation ablation, were associated with a better prognosis (permutation feature importance: 0.0047 ± 0.00011, 0.0014 ± 0.000073, and 0.00095 ± 0.000097, respectively), except in cases where these invasive treatments preceded or followed hospitalization for cardiac decompensation. The predominant negative prognosis sequences were mostly those that included HF-related hospitalizations before or after other-related hospitalizations (permutation feature importance: 0.0007 ± 0.000091 and 0.00011 ± 0.000045, respectively). CONCLUSIONS We highlight the value of healthcare trajectories on frequent hospitalization sequences, mortality, and prognosis and indicate the necessary prognostic value of HF re-hospitalization. Our work may be an essential tool for better identification of at-risk patients in order to increase and improve personalized care in the future.
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Affiliation(s)
- Camille Nevoret
- CEMKA, Bourg-la-Reine, France
- Clinical Research Unit, CIC-EC 1418, European Hospital Georges-Pompidou, APHP, Paris, France
| | - Yohann Tran
- Clinical Research Unit, CIC-EC 1418, European Hospital Georges-Pompidou, APHP, Paris, France
| | - Soulef Guendouz
- Referral Center for Cardiac Amyloidosis, Mondor Amyloidosis Network, GRC Amyloid Research Institute and Cardiology Department, INSERM Unit U955, Team 8, Paris-Est Creteil University, Hospital Henri Mondor, Val-de-Marne, Créteil, France
| | - Audrey Lavenu
- Univ Rennes, CIC 1414 INSERM, IRMAR, Mathematics Institute of Rennes CNRS, Rennes, France
| | - Sandrine Katsahian
- Clinical Research Unit, CIC-EC 1418, European Hospital Georges-Pompidou, APHP, Paris, France
| | - Thibaud Damy
- Referral Center for Cardiac Amyloidosis, Mondor Amyloidosis Network, GRC Amyloid Research Institute and Cardiology Department, INSERM Unit U955, Team 8, Paris-Est Creteil University, Hospital Henri Mondor, Val-de-Marne, Créteil, France
| | - Anne-Isabelle Tropeano
- Clinical Research Unit, CIC-EC 1418, European Hospital Georges-Pompidou, APHP, Paris, France
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Vanasse A, Chiu YM, Courteau J, Dorais M, Bartlett G, Zawaly K, Benigeri M. Cohort Profile: The Care Trajectories-Enriched Data (TorSaDE) cohort. Int J Epidemiol 2021; 50:1066-1066h. [PMID: 33236074 DOI: 10.1093/ije/dyaa167] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Alain Vanasse
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke (QC), Canada.,PRIMUS Research Group, Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke (QC), Canada.,Québec SPOR-Support Unit, Montréal (QC), Canada
| | - Yohann M Chiu
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke (QC), Canada.,PRIMUS Research Group, Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke (QC), Canada
| | - Josiane Courteau
- PRIMUS Research Group, Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke (QC), Canada
| | | | - Gillian Bartlett
- Department of Family Medicine, McGill University, Montréal (QC), Canada
| | - Kristina Zawaly
- Department of Family Medicine, McGill University, Montréal (QC), Canada
| | - Mike Benigeri
- Québec SPOR-Support Unit, Montréal (QC), Canada.,Public Health School, Université de Montréal, Montréal (QC), Canada
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Jouan Y, Grammatico-Guillon L, Teixera N, Hassen-Khodja C, Gaborit C, Salmon-Gandonnière C, Guillon A, Ehrmann S. Healthcare trajectories before and after critical illness: population-based insight on diverse patients clusters. Ann Intensive Care 2019; 9:126. [PMID: 31707487 PMCID: PMC6842359 DOI: 10.1186/s13613-019-0599-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 10/23/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The post intensive care syndrome (PICS) gathers various disabilities, associated with a substantial healthcare use. However, patients' comorbidities and active medical conditions prior to intensive care unit (ICU) admission may partly drive healthcare use after ICU discharge. To better understand retative contribution of critical illness and PICS-compared to pre-existing comorbidities-as potential determinant of post-critical illness healthcare use, we conducted a population-based evaluation of patients' healthcare use trajectories. RESULTS Using discharge databases in a 2.5-million-people region in France, we retrieved, over 3 years, all adult patients admitted in ICU for septic shock or acute respiratory distress syndrome (ARDS), intubated at least 5 days and discharged alive from hospital: 882 patients were included. Median duration of mechanical ventilation was 11 days (interquartile ranges [IQR] 8;20), mean SAPS2 was 49, and median hospital length of stay was 42 days (IQR 29;64). Healthcare use (days spent in healthcare facilities) was analyzed 2 years before and 2 years after ICU admission. Prior to ICU admission, we observed, at the scale of the whole study population, a progressive increase in healthcare use. Healthcare trajectories were then explored at individual level, and patients were assembled according to their individual pre-ICU healthcare use trajectory by clusterization with the K-Means method. Interestingly, this revealed diverse trajectories, identifying patients with elevated and increasing healthcare use (n = 126), and two main groups with low (n = 476) or no (n = 251) pre-ICU healthcare use. In ICU, however, SAPS2, duration of mechanical ventilation and length of stay were not different across the groups. Analysis of post-ICU healthcare trajectories for each group revealed that patients with low or no pre-ICU healthcare (which represented 83% of the population) switched to a persistent and elevated healthcare use during the 2 years post-ICU. CONCLUSION For 83% of ARDS/septic shock survivors, critical illness appears to have a pivotal role in healthcare trajectories, with a switch from a low and stable healthcare use prior to ICU to a sustained higher healthcare recourse 2 years after ICU discharge. This underpins the hypothesis of long-term critical illness and PICS-related quantifiable consequences in healthcare use, measurable at a population level.
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Affiliation(s)
- Youenn Jouan
- Service de Médecine Intensive Réanimation, CHRU de Tours, 2 Bd Tonnellé, 37044, Tours Cedex 9, France. .,INSERM U1100 Centre d'Etudes des Pathologies Respiratoires, Faculté de Médecine, Tours, France. .,Université de Tours, Tours, France.
| | - Leslie Grammatico-Guillon
- Service d'Information Médicale, d'Epidémiologie et d'Economie de la Santé, CHRU Tours, Tours, France.,INSERM CIC1415, CHRU Tours, Tours, France
| | - Noémie Teixera
- Service d'Accueil et d'Urgences, CHRU Tours, Tours, France
| | - Claire Hassen-Khodja
- Service d'Information Médicale, d'Epidémiologie et d'Economie de la Santé, CHRU Tours, Tours, France.,INSERM CIC1415, CHRU Tours, Tours, France
| | - Christophe Gaborit
- Service d'Information Médicale, d'Epidémiologie et d'Economie de la Santé, CHRU Tours, Tours, France
| | - Charlotte Salmon-Gandonnière
- Service de Médecine Intensive Réanimation, CHRU de Tours, 2 Bd Tonnellé, 37044, Tours Cedex 9, France.,Université de Tours, Tours, France
| | - Antoine Guillon
- Service de Médecine Intensive Réanimation, CHRU de Tours, 2 Bd Tonnellé, 37044, Tours Cedex 9, France.,INSERM U1100 Centre d'Etudes des Pathologies Respiratoires, Faculté de Médecine, Tours, France.,Université de Tours, Tours, France.,INSERM CIC1415, CHRU Tours, Tours, France
| | - Stephan Ehrmann
- Service de Médecine Intensive Réanimation, CHRU de Tours, 2 Bd Tonnellé, 37044, Tours Cedex 9, France.,INSERM U1100 Centre d'Etudes des Pathologies Respiratoires, Faculté de Médecine, Tours, France.,Université de Tours, Tours, France.,INSERM CIC1415, CHRU Tours, Tours, France.,CRICS-TriggerSep Research Network
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