BACKGROUND:Sodium-glucose cotransporter 2 (SGLT2) inhibitors are recommended across the spectrum of heart failure (HF), yet data on their real-world uptake remain limited. We evaluated temporal trends and clinical determinants of SGLT2 inhibitor use in patients enrolled in a nationwide HF remote monitoring programme (RMP). METHODS:This analysis included 13,660 adults with chronic HF (median age 78 years, 43% women, 46% HFrEF) enrolled in a nationwide RMP between 2021 and 2024. Temporal patterns of SGLT2 inhibitor uptake were assessed across four predefined periods aligned with major trial and guideline publication. RESULTS:Overall, 64.4% of patients received an SGLT2 inhibitor at programme entry. Uptake increased markedly over time but followed distinct phenotype-specific patterns. In HFrEF, adoption rose sharply following the 2021 ESC HF Guidelines update and subsequently plateaued. In HFmrEF/HFpEF, uptake increased steeply after publication of EMPEROR-Preserved, then more gradually after DELIVER, reaching a plateau following the 2023 ESC HF guideline update. Study period (with progressively higher adjusted odd ratios [aOR] across periods 6.4-28.8), diabetes (aOR 1.39), home-visiting nurse assistance (aOR 1.52), and follow-up in university hospitals (aOR 2.12) were associated with higher SGLT2 inhibitor prescription, whereas HFmrEF (aOR 0.52), HFpEF (aOR 0.31), and chronic kidney disease (CKD; aOR 0.75) were associated with lower use. CONCLUSIONS:In this nationwide RMP, SGLT2 inhibitor prescription at programme entry increased rapidly following major trial and guideline publications, reaching high levels across HF phenotypes, although CKD remained associated with lower prescription, suggesting a residual opportunity for treatment optimization. TRIAL REGISTRATION:ClinicalTrials.gov #NCT07022379.

Heart failure is a common condition that leads to a large number of hospitalizations, a high mortality rate, and significant costs for the healthcare system. The symptoms and chronic nature of the disease severely impair patients' quality of life, forcing them to adapt their daily routines by following various lifestyle and dietary recommendations, including salt restriction. This diet, often presented as essential, can have mixed effects: while it may sometimes reduce the risk of rehospitalization, it can also increase it, particularly when it leads to dehydration. Furthermore, the impact of a low-sodium diet on quality of life remains significant.

Introduction Heart failure (HF) is a growing public health concern, particularly among aging populations. The European Society of Cardiology Guidelines recommend an evidence-based approach that combines pharmacological therapies, device interventions, and lifestyle measures. Objective The REMOTE-HF study, conducted using the Satelia® Cardio remote monitoring platform, assessed adherence to these guidelines, described patient clinical characteristics, and evaluated the role of telemonitoring in optimizing treatment. Method The study included 20,310 HF patients monitored via Satelia® Cardio, with data extracted as of December 15, 2024. Key parameters analyzed included age, sex, NYHA classification, left ventricular ejection fraction (LVEF), and HF etiology. Prescribed therapies (ACE inhibitors/ARBs/ARNi, beta-blockers, mineralocorticoid receptor antagonists [MRAs], and SGLT2 inhibitors) were compared with ESC guideline recommendations, considering patient profiles and cardiologist practice settings (hospital-based vs. private practice). Results Most patients were classified as NYHA class II (63%), and 45% had reduced LVEF (<40%). The most common etiology was ischemic heart disease (43%). Among patients with reduced LVEF, adherence to ESC guidelines was high: beta-blockers were prescribed to 67%, ARNi to 59%, MRAs to 60%, and SGLT2 inhibitors to 57%. Overall, SGLT2 inhibitors were more frequently used than MRAs (43% vs. 39%) and were widely adopted in patients with LVEF 40–50% (48%), but remained underused in those with preserved LVEF (≥50%) at 38%. SGLT2 inhibitor use was higher in men (45%) and in patients under 80 years of age (47%). There was also relatively consistent prescription of beta-blockers (54–55%) and ARNi (31–32%) between hospital-based and private-practice cardiologists. However, variations remained in other drug classes and among patients with preserved LVEF or complex comorbidities (Table 1). Conclusion The REMOTE-HF study illustrates the value of remote monitoring in enhancing adherence to ESC heart failure treatment guidelines, particularly in patients with reduced EF. The increased use of SGLT2 inhibitors marks a significant shift in clinical practice. Nevertheless, the study reveals persistent gaps in care, especially among older patients and those with preserved ejection fraction. These findings underscore the importance of telemonitoring as a lever to standardize therapeutic management and improve outcomes across all care settings.

Background: Heart failure is associated with reduced quality of life, hospitalizations, death and high healthcare costs. Despite care improvements, the rehospitalization rate after an acute heart failure episode, especially for acute heart failure, remains high.Methods: The Education Strategy for patients with acute Heart Failure (EduStra-HF; ClinicalTrials.gov Identifier NCT03035123) study will randomize patients admitted for acute heart failure in six French hospitals to usual care (control) or therapeutic education (intervention). All patients will be evaluated at baseline and will meet with a therapeutic education nurse before discharge. Those in the usual care arm will have standard appointments with their cardiologist and general practitioner. Those in the intervention arm will have an intensive follow-up schedule of phone calls, home visits and text messages from the therapeutic education nurses, plus cardiologist visits. Patients will be stratified by discharge location (home or cardiac rehabilitation centre) before randomization, and will be followed up for 1 year. The primary outcome will be the readmission rates for acute heart failure during 1 year in the two groups. Secondary outcomes will include: quality of life; time from inclusion to first readmission for acute heart failure; non-heart failure cardiovascular rehospitalization rates; length of stay for heart failure; cardiovascular and all-cause death; rates of patients receiving optimal medical therapies; evolution of knowledge about heart failure; and cost-effectiveness.Conclusions: This study will assess the efficacy and feasibility of a standardized management strategy for the care and follow-up of patients discharged after hospitalization for acute heart failure. The EduStra-HF strategy will combine various nurse care methods to help prevent rehospitalization.

Introduction: In heart failure (HF), most of the data available on myocardial strain focused on the left ventricle (LV). Very few data concern the other cavities. Hypothesis: We hypothesized that all cardiac cavities are involved in HF and thus we evaluated all chambers strain profiles in patients admitted with acute HF. Methods: We prospectively evaluated 95 patients hospitalized for HF. Patients were divided into preserved left ventricle ejection fraction (LVEF) (LVEF ≥50%, HFpEF n=24), mildly reduced LVEF ((LVEF 41-49%, HFmrEF n=17), and reduced left ventricular ejection fraction (LVEF) (LVEF ≤40%, HFrEF n=54). In addition to the usual two-dimensional echocardiographic parameters, LV global longitudinal strain, left and right atrial strain (reservoir, conduit, contractile strain), right ventricular free wall strain were determined using speckle tracking transthoracic echocardiography at admission. Results: Patients with HFrEF were younger in comparison with patients with HFmrEF and HFpEF, (respectively 66.3 ± 14.2, 78.3.0 ±8.7, 75.6 ± 10.2 years p<0.001). Table 1 summarizes the main Doppler and echocardiographic comparisons. Myocardial strain analyses demonstrated that patients with HFrEF had significant lower LV global, right ventricular strain, left atrial reservoir strain, left and right atrial conduit strain (Figure 1). Conclusions: Beyond the alteration of LV function, HFrEF involves alteration of right ventricle, left and right atrial functions. Strain analysis is an interesting tool in addition to conventional echocardiographic parameters to assess heart function in heart failure. The prognostic impact of these finding remains to be studied.

IMPORTANCELifestyle improvements after an acute coronary syndrome reduce cardiovascular risk but are difficult to achieve.OBJECTIVETo determine whether a nurse-led or dietician-led cardiovascular risk factor education program would improve risk factor reduction over the long term after an acute coronary syndrome.DESIGN, SETTING, AND PARTICIPANTSThe Réseau Insuffisance Cardiaque (RESICARD) PREVENTION: study was a 2-arm, parallel-group, multicenter, randomized clinical trial at 6 tertiary care hospitals in France. Patients hospitalized in a cardiac intensive care unit for an acute coronary syndrome with at least 1 lifestyle risk factor (current smoking, sedentary lifestyle, or overweight or obesity) were randomized according to a computer-generated list with sequentially numbered, sealed envelopes.INTERVENTIONPatients underwent an education program in a unique non-hospital setting (a House of Education) or were treated according to physicians' usual standard of care.MAIN OUTCOMES AND MEASURESThe primary outcome was a composite that included at least 1 of the following: smoking cessation, at least 3 hours per week of physical activity, at least 5% reduction in weight, and at least 4% reduction in waist circumference. Patients were followed up for 1 year. An intent-to-treat analysis was performed. RESULTS From June 21, 2006, to July 30, 2008, a total of 251 patients were randomized to the House of Education and 251 to conventional care. The 2 groups did not differ significantly at 12 months in the primary composite outcome (51.8% vs 49.8% success rate; adjusted relative risk [aRR], 1.11; 95% CI, 0.90-1.37) or with correction of all risk factors (aRR, 1.22; 95% CI, 0.89-1.66). Similarly, the 2 groups did not differ by physical activity (aRR, 1.05; 95% CI, 0.92-1.21), smoking cessation (aRR, 0.99; 95% CI, 0.87-1.13), and weight or waist reduction (aRR, 1.07; 95% CI, 0.84-1.36).CONCLUSIONS AND RELEVANCECompared with conventional care, the House of Education did not result in superior improvement in lifestyle-related cardiovascular risk factors after an acute coronary syndrome.TRIAL REGISTRATIONclinicaltrials.gov Identifier: NCT00337480.

Background. - No clinical practice guidelines are available for the treatment of heart failure (HF) in patients with preserved left ventricular ejection fraction (LVEF).Aims. - To determine how cardiologists manage medical treatment in HF patients after hospital discharge, according to LVEF.Methods. - The FUTURE study was a cross-sectional survey conducted in HF outpatients by French private cardiologists between September 2007 and August 2008. Patients had to have been hospitalized within the previous 18 months with a diagnosis of HE Clinical data and HF treatments (angiotensin-converting enzyme inhibitors [ACEIs], angiotensin receptor blockers [ARBs], beta-blockers, diuretics and aldosterone antagonists) were recorded retrospectively, with precise information on drug doses, at two successive time points (at hospital discharge and at the index consultation). HF treatment was compared in patients with reduced (less than or equal to 40%) versus preserved (more than 40%) LVEF.Results. - Completed data were available for 1137 HF patients enrolled by 424 cardiologists. Mean patient age was 72 +/- 11 years; LVEF was reduced in 56% and preserved in 44%. The therapeutic approach was similar in the two groups, both at hospital discharge and at the index consultation. At the index consultation, HF treatment was: beta-blocker (74%); ACEI/ARB (83%); loop diuretic (86%); aldosterone antagonist (31%). The majority of patients (62%) received a beta-blocker plus an ACEI or an ARB; 56% reached more than or equal to 50% of the target dose for each treatment. There were no major differences in treatments and dosages between the groups with low and preserved LVEE In 15% of cases where the drug dose was not increased, fear of adverse events was reported as the reason.Conclusion. - The FUTURE survey showed a similar approach to HF treatment irrespective of LVEF. Compared with previous studies, we saw an improvement in the use of recommended HF drugs, especially beta-blockers. However, achievement of target doses could be improved. (C) 2012 Published by Elsevier Masson SAS.

The part of elderly patients (pts) in heart failure (HF) population is growing. They might pose specific problems due to the greater proportion of HF with preserved LVEF, more frequent comorbidities or contra-indications to recommended HF treatment. to describe the care management of pts > 80-year treated for HF in France. Cross sectional observational survey with retrospective collection of data at hospital discharge. Pts must have been diagnosed with CHF and have been hospitalised for CHF within the previous 18 months. Pts are classified according to the LVEF at hospital discharge. 412 French outhospital cardiologists entered 1 452 pts meeting the inclusion criteria. FEVG at hospital discharge was known for 1408 pts. 355 (25%) were more than 80-year-old. Management care at hospital discharge according to age and LVEF is detailed below.Empty CellEmpty CellLVEF < 40%LVEF 40-50%LVEF > 50%TotalAge>80ACEI/ARB84%81%80%82%*BB71%67%40%†,‡62%*Loop diuretics92%85%85%88%Spironolactone/eplerenone26%20%18%22%*Digoxin20%15%29%21%*Calcium antagonists10%14%37%†,‡18%Anticoagulants49%45%51%49%*Age≤80ACEI/ARB93%93%85%†,‡92%BB79%78%76%79%Loop diuretics90%82%79%†,§86%Spironolactone/eplerenone35%21%25%†,§30%Digoxin16%15%16%15%Calcium antagonists9%19%21%†,§13%Anticoagulants42%39%39%41%†p<0.05 for comparisons between LVEF > 50% and LVEF<40%;‡p<0.05 for comparisons between LVEF>50% and LVEF between 40% and 50%;§: p<0.05 for comparisons between LVEF<40% and LVEF between 40% and 50%;*p<0.05 for comparisons between > 80 and ≤ 80 years old adjusted for LVEF. p<0.05 for comparisons between LVEF > 50% and LVEF<40%; p<0.05 for comparisons between LVEF>50% and LVEF between 40% and 50%; : p<0.05 for comparisons between LVEF<40% and LVEF between 40% and 50%; p<0.05 for comparisons between > 80 and ≤ 80 years old adjusted for LVEF. BB, ACEI/ARB, spironolactone/eplerenone are less often prescribed in elderly patients contrasting with digoxin and anticoagulants prescription. These differences persist after adjustment on LVEF.

Recent registries have shown that recommended drugs for the treatment of congestive heart failure (CHF) remain under-prescribed in daily practice. To compare prescription rates of CHF drugs in three French surveys Impact Reco I, II and III. We included outpatients followed by private cardiologists: 1947 in Impact Reco I (2005), 1974 in Impact Reco II (2005/2006) and 1574 in Impact Reco III (2007), with NYHA class II-IV heart failure and a left ventricular ejection fraction < 40%, and we compared treatment modalities. Recommended treatments and target doses were defined according to ESC guidelines. There was an improvement in both the rate of prescription, and in the proportion of patients reaching target dose or 50% of target dose of ACE I, ARBs and beta blockers (see table). We observed an improvement with time in the management of CHF outpatients with an increase in prescription rates of recommended CHF drugs, as well as in the dosage used for ACE-I, ARB and beta-blockers, Prescription IMPACT I 2005 IMPACT II 2005/2006 IMPACT III 2007 Global population 1917 1974 1574 ACE I Number patients with prescription N (%) 1361 (71.0) 1349 (68.3) 1099 (70.2) Target dose % 48.7 57.3 * 52.3 • 50% Target dose % 80.4 84.5 * 88.4 † , • ARBs Number patients with prescription N (%) 395 (20.6) 592 (30.0) * 516 (33.3) † , • Target dose % 9.1 7.4 20.7 † , • 50% Target dose % 52.9 49.7 68.6 † , • Betablockers Number patients with prescription N (%) 1245 (65.2) 1382 (70.0) * 1229 (78.3) † , • Target dose % 18.4 23.4 * 25.7 † 50% Target dose % 47.3 53.5 * 59.9 †• * : p<0.05 Impact II vs I • : p<0.05 Impact III vs II † : p<0.05 Impact III vs I although there is still room for improvement particularly for beta blockers. These encouraging findings suggest a better awareness and implementation of ESC guidelines by French private cardiologists.

HF treatment is often started during hospitalisation. It appeared interesting to describe the evolution of treatment after hospital discharge. To describe changes in HF treatment since hospital discharge after stratification on the time elapsed between discharge and beginning of the survey. Cross sectional observational survey with retrospective collection of data at hospital discharge. Patients must have been diagnosed with HF and have been hospitalised for HF within the previous 18 months. 1452 HF patients met the inclusion criteria and started the survey. 1170 (67% males, age 72±11 years, LVEF 40%±13%) have had at least one visit by the cardiologist between hospital discharge and entry in the survey. Patients were stratified according to the time since hospital discharge (<3 months N=414, 3-6 months N=297, 6-12 months N=296, 12 to 18 months N=163). At hospital discharge, recommended betablocker, ACEI (of which perindopril) or ARB, are prescribed respectively to 826 (70,6%), 807 (69,0%) and 170 (14,5%) patients. Target doses were reached in 87 (10.5%) patients with betablocker, 411 (50.9%) patients with ACEI, 7 (4.1%) patients with ARB and 417 (43.4%) patients with either ACEI or ARB. At start of the survey, target doses were reached in 176 patients (20.4%) treated with betablockers, 470 patients (59.6%) treated with ACEI, 16 patients (7.2%) receiving ARB and 484 patients (49.7%) receiving either ACEI or ARB. Rates of patients reaching the target dose for betablockers increased significantly with time (from 19.5% to 29.8% p=0.01). No significant changes were noticed for ACEI or ARB. Treatment strategies for Heart Failure started at hospital are well followed and amplified by French outhospital cardiologists after hospital discharge.

Heart failure (HF) with preserved LVEF has been individualized in the recent years as a specific entity, with different mechanisms, special baseline characteristics, a poor prognosis and no clearly recognized treatment. Recent papers have focused on patients with LVEF between 40% and 50% who could not be clearly classified as patients with reduced or preserved LVEF. to describe the management care of patients according to the LVEF with special emphasis on patients belonging to the “grey zone”. Cross sectional observational survey with retrospective collection of data at hospital discharge. Patients must have been diagnosed with HF and have been hospitalised for HF within the previous 18 months. Patients are classified according to the LVEF at hospital discharge. 412 French outhospital cardiologists included 1 452 patients meeting the inclusion criteria. Management care at hospital discharge according to LVEF (known in 1 408 patients) is detailed below. This is the first French survey in patients managed by cardiologists after hospital discharge for HF. Cardiologists mainly care for patients with low LVEF. Treatment at hospital discharge is optimal regarding medical classes, with poor differences according to EF. Rate of betablockers and ACEI is quite high in the group with EF > 50%, even if it is lower than in the groups with low EF. As a whole, in France, the 40-50% group is managed as the < 40% one.Table. Drug therapy according to LVEFEmpty CellLVEF<40% n=792LVEF 40-50% n=366LVEF>50% n=250pACEI/ARB91%90%†83%0,002Betablocker78%76%†64%<0,0001Loop diuretics90%83%*82%<0,001Spironolactone29%19%*21%0,0003Digoxin16%15%21%0,15Calcium antagonists9%18%†*27%<0,0001Anticoagulants43%41%43%0,64p by ANOVA with Bonferroni correction;†p<0.05 for comparisons between “grey zone” and LVEF>50%;*p<0.05 for comparisons between “grey zone” and LVEF<40%. Table. Drug therapy according to LVEF p by ANOVA with Bonferroni correction; p<0.05 for comparisons between “grey zone” and LVEF>50%; p<0.05 for comparisons between “grey zone” and LVEF<40%.

The recent European Guidelines for the treatment of CHF 2008 underlined that the majority of patient with CHF and COPD can safely tolerate β-blocker therapy. The IMPACT-RECO program III analysed the impact of NYHA class and of comorbidities on therapeutic management of French outpatients with stable CHF and left ventricular ejection fraction (LVEF) < 40%. This survey was carried out from March 2007 to December 2007 among randomly selected French private cardiologists. 1574 patients with CHF and LVEF < 40% were included. Key demographics including comorbidities such as asthma and COPD, as well as ongoing medical treatment of CHF were collected. Physicians were asked about reasons for not prescribing β-blockers. Mean age was 71 ± 11 years, 75% of the patients were men, 34% were in NYHA class III-IV, 54% had coronary artery disease, 30% atrial fibrillation and the mean LVEF was 34 ± 7%. 78.3% of the patients received a β-blocker, and asthma or BPCO were reported in 13.7%. 341 patients were not receiving β-blockers. The first reason for non-prescription was presumed contra-indication in 51.9% (177 pts). This contra-indication was asthma or COPD in 71%, symptomatic hypotension in 15%, bradycardia in 12% and other problems in 8%. The second reason for non prescribing β-blockers was previous side effects in 35.2% (120 pts) including heart failure decompensation in 39%, symptomatic hypotension in 36%, asthenia in 26%, bradycardia in 18%, impotence in 5% and others in 6%. Lastly, in 10.9% of patients without β-blockers, the reason for non prescription was fear of potential side effect. Respiratory disease remains the main reason for not prescribing β-blockers in CHF despite the fact that selective β-blockers are now recommended in this population. Room remains for improvement in β-blockers prescription rate in CHF patients with concomitant COPD, underscoring the importance of pursuing education of cardiologists.

Heart failure (HF) treatment is often started during hospitalisation and patients are generally taken over after discharge by outhospital cardiologists. To describe changes in HF treatment implemented by the outhospital cardiologist after hospital discharge. Cross sectional observational survey with retrospective collection of data at hospital discharge. Patients must have been diagnosed with HF and hospitalized for HF within the previous 18 months. 1 452 patients were included by 412 French outhospital cardiologists. 1170 have had at least one visit by the cardiologist between hospital discharge (mean delay 5.76±4.51 months). At hospital discharge, target doses were reached in 10.5% of patients receiving betablockers, 50.9% of patients with ACEI and in 4.1% of patients with ARB. Doses were increased in 25.3% of patients receiving betablockers, in 11.7% of patients receiving ACEI and in 10.3% of patients treated with ARB enabling a target dose in 20.4% of patients with betablockers, and in 83.2% of patients with ACEI or an ARB. Table. Evolution of treatment after discharge At hospital discharge At start of the survey Medication prescribed after discharge Medication discontinued after discharge Betablocker 826 (70,6%) 863 (73,8%) 87 (25,3%) * 50 (6,1%) * ACEI †† 807 (69,0%) 788 (67,4%) 46 (12,7%) * 65 (8,1%) ** ARB ‡ 170 (14,5%) 210 (18,0%) 56 (5,6%) * 16 (9,4%) ** ACEI or ARB 961 (82,1%) 973 (83,2%) - - * percentages calculated on the number of patients without the treatment at hospital discharge; ** percentages calculated on the number of patients without the treatment at hospital discharge; metoprolol, nebivolol, bisoprolol, carvedilol; †† captopril, enalapril, lisinopril, trandolapril, ramipril, perindopril (at an accepted target dose of 4mg); ‡ candesartan, valsartan Outhospital cardiologists play a critical role in care management of HF patients. Not only do they implement but they also amplify the care strategies defined during hospitalisation.

Heart Failure (HF) with preserved LVEF has been individualized in recent years as a specific entity, with different mechanisms, special baseline characteristics, a poor prognosis and no clearly recognized treatment. LVEF cut-off has not been clearly defined. If 50% is generally accepted as a rather specific cut-off, there remains a « grey zone » of patients with EF between 40% and 50% not clearly individualized between reduced and preserved LVEF. to describe the characteristics of patients with LVEF belonging to the “grey zone” and to compare these patients to those with either reduced or preserved LVEF. Cross sectional observational survey with retrospective collection of data at hospital discharge. Patients must have been diagnosed with HF and have been hospitalized for HF within the previous 18 months. Patients are classified according to the LVEF at hospital discharge. 412 French outhospital cardiologists included 1 452 patients with the inclusion criteria. This is the first French survey in patients managed by cardiologists after hospital discharge for HF. Cardiologists mainly care for patients with low LVEF. Overall, the profile of patients with LVEF 40-50% at hospital discharge is closer to the < 40% than to the >50% LVEF group. Characteristics according to LVEF at discharge (n=1 408) are displayed below.Table. Patients characteristics according to EFEmpty CellLVEF<40% n=792LVEF 40-50% n=366LVEF>50% n=250PAge71±1273±11†76±110,0001Men74%65%47%0,0001Ischemic etiology53%55%†,*42%0,003Hypertensive etiology30%51%†64%<0,0001Valvular etiology12%17%†,*25%<0,0001Dilated cardiomyopathy44%25%†,*8%<0,0001Renal dysfunction37%34%†27%0,01Sinus rhythm71%69%†60%0,008Discharge BNP (pg/ml)4393253200,01DischargeNYHA class III-IV41%29%†,*21%<0,0001p by ANOVA with Bonferroni correction;†p<0,05 for comparisons between “grey zone” and LVEF>50%;*p<0,05 for comparisons between “grey zone” and LVEF<40%. Comparisons for age adjusted for sex. Table. Patients characteristics according to EF p by ANOVA with Bonferroni correction; p<0,05 for comparisons between “grey zone” and LVEF>50%; p<0,05 for comparisons between “grey zone” and LVEF<40%. Comparisons for age adjusted for sex.

European Guidelines for the treatment of CHF 2008 underline that there is no absolute level of creatinine which precludes the use of angiotensin converting enzyme inhibitors (ACE-Is) or angiotensin receptor blocker (ARBs). The IMPACT-RECO program III analysed the impact of NYHA class and of comorbidities on therapeutic management of French outpatients with stable CHF and low left ventricular ejection fraction (LVEF). This survey was carried on 2007 among randomly selected French private cardiologists. 1574 patients with CHF and LVEF < 40% were included. Mean age was 71 ± 11 years, 75% of the patients were men, 34% were in NYHA class III-IV, 54% had coronary artery diseases, 30% had atrial fibrillation and the mean LVEF was 34 ± 7%. Creatinine value was recorded in 1332 patients. Mean creatinine concentration was 119 ± 50 μmol/L and mean creatinine clearance was 59.6 ± 26.8 ml/kg/min. Renal dysfunction defined by creatinine concentration > 220 μmol/L or 25 mg/dL was found in 173 patients. In the 467 patients not receiving ACEIs, reasons for non prescription were firstly contra-indication in 69 patients (14.8%) mostly because of renal dysfunction in 54 patients (78.3%), secondly side effects in 365 patients (78.2%) with renal insufficiency found in 25 patients (6.85%). In 1033 patients, ARBs was also not prescribed because of contra-indication for renal dysfunction in 79 patients (90.8%), or intolerance with renal insufficiency in 40 patients (32.8%). Thus, despite a mean creatinine clearance of 33.3 ± 15.1 mL/kg/min in 173 patients with renal dysfunction, ACEIs/ARB were not prescribed in 133 patients considering renal dysfunction as a contra-indication. Renal dysfunction remains the main reason for not prescribing ACEIs/ARBs in CHF despite the possibility to easily adapt their dose to creatinine clearance. Improvement is still necessary so that ACEIs/ARBs should not be denied to CHF patients with concomitant renal dysfunction.

Background. - Heart failure presents a major public health problem due to its high prevalence and the increasing number of hospital admissions for this condition. A coordinated healthcare network involving general, practitioners and cardiologists was set up in the east of Paris in an effort to improve the management and outcomes of patients with severe heart failure.Aims. - To reinforce patient education, improve compliance with medications and identify symptoms requiring treatment modification.Methods. - In this 'before and after' study, the control group comprised patients hospitalized for severe heart failure who received conventional management in the year preceding the network set-up. The comparative group consisted of patients hospitalized for severe heart failure who underwent network-led care.Results. - No significant differences were found between rates of first rehospitalization and all-cause mortality at 1 year between control and network groups, or between rates of first hospitalization due to cardiac causes, time to the first event, duration of hospitalization, rates of cardiac death or time to death.Conclusions. - In this non-randomized study, we found no benefit from management according to the RESICARD healthcare network in terms of mortality or hospitalization in patients with severe chronic heart failure. (C) 2009 Published by Elsevier Masson SAS.