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Canadian Journal of Cardiology

Management and Outcome of Patients Admitted With Tricuspid Regurgitation in France

Published:December 20, 2020DOI:https://doi.org/10.1016/j.cjca.2020.12.012

      Abstract

      Background

      Growing evidence shows a major outcome impact and undertreatment of tricuspid regurgitation (TR), but large and comprehensive contemporary reports of management and outcome at the nationwide level are lacking.

      Methods

      We gathered all consecutive patients admitted with a diagnosis of likely functional TR in 2014-2015 in France from the Programme de Médicalisation des Systèmes d’Information national database and collected rate of surgery, in-hospital mortality, 1-year mortality, or heart failure (HF) readmission rates.

      Results

      In 2014-2015, 17,676 consecutive patients (75 ± 14 years of age, 51% female) were admitted with a TR diagnosis. Charlson index was ≥ 2 in 56% of the population and 46% presented with HF. TR was associated with prior cardiac surgery, ischemic/dilated cardiomyopathy, or mitral regurgitation in 73% of patients. Only 10% of TR patients overall and 67% of those undergoing mitral valve surgery received a tricuspid valve intervention. Among the 13,654 (77%) conservatively managed patients, in-hospital mortality, 1-year mortality, and 1-year mortality or HF readmission rates were 5.1%, 17.8%, and 41%, respectively, overall, and 5.3%,17.2%, and 37%, respectively, among those with no underlying medical conditions (8-fold higher than predicted for age and gender).

      Conclusions

      This nationwide cohort of patients admitted with TR included elderly patients with frequent comorbidities/underlying cardiac diseases. In patients conservatively managed, mortality and morbidity were considerably high over a short time span. Despite this poor prognosis, only 10% of patients underwent a tricuspid valve intervention. These nationwide data showing a considerable risk and potential underuse of treatment highlight the critical need to develop strategies to improve the management and outcomes of TR patients.

      Résumé

      Contexte

      De plus en plus de données montrent que l’insuffisance tricuspide (IT) influence le pronostic et est fréquemment sous-traitée. Toutefois, des données issues de larges registres nationaux évaluant la prise en charge et le devenir des patients présentant une IT sont rares.

      Méthodologie

      Nous avons extrait de la base de données nationale du Programme de médicalisation des systèmes d’information (France) les renseignements relatifs aux patients consécutifs admis en 2014-2015 dans un hôpital français en raison d’un diagnostic de IT vraisemblablement fonctionnelle, afin d’examiner les taux d’intervention chirurgicale, de mortalité hospitalière, de mortalité à 1 an et de réadmission pour insuffisance cardiaque.

      Résultats

      En 2014-2015, 17 676 patients consécutifs (75 ± 14 ans, 51 % de femmes) ont été hospitalisés avec un diagnostic d’IT ; 56 % présentaient un indice de Charlson ≥ 2 et 46 % une insuffisance cardiaque. L’IT était associée à un antécédent de chirurgie cardiaque, une cardiomyopathie dilatée ou ischémique ou à une insuffisance mitrale dans 73 % des cas. Dans l’ensemble de la population, seuls 10 % des patients présentant une IT ont été opérés sur la valve tricuspide et seulement 67 % de ceux opérés sur la valve mitrale ont bénéficié d’une chirurgie concomitante sur la valve tricuspide. Parmi les 13 654 patients pris en charge médicalement, le taux de mortalité hospitalière, de mortalité à 1 an et de mortalité à un an ou de réadmission pour insuffisance cardiaque étaient respectivement de 5,1 %, 17,8 % et 41 % dans l’ensemble de la population et 5,3 %, 17,2 % et 37 % chez ceux présentant une IT en l’absence de pathologie associée (taux huit fois plus élevés que ceux attendu dans une population de même âge et sexe).

      Conclusions

      Dans cette large cohorte française regroupant tous les patients admis pour une IT en 2014-2015, la majorité des patients était âgés avec de fréquentes comorbidités. La mortalité et morbidité à court terme des patients pris en charge médicalement était considérable. Malgré ce sombre pronostic, seuls 10 % des patients ont bénéficié d’une chirurgie tricuspide. Ces données, montrent à l’échelle nationale, l’insuffisance de traitement et risque considérable encouru par les patients présentant une IT et la nécessité de développer de nouvelles approches pour améliorer leur prise en charge et leur devenir.
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