Transcript Brite session: Dealing with difficult situations in primary care

Brite session:
Dealing with difficult
situations in primary care
Camille De Franceschi
Cabinet Médical Marcel Monny Lobe, Soisy-sous-Montmorency, France
The case of Mr M. 80 years old
• High blood pressure, ischemic heart disease and arrhythmia (AF
under oral anticoagulant), hyperlipidaemia, chronic renal failure,
Chronic Obstructive Pulmonary Disease, weaned smoking.
• He complained of an increase dyspnea, as well as a recent
"orthopnea", and lower limb oedema with a limited walking.
• Clinically, the patient had a NYHA stage III, TA: 150/90 mmHg,
an irregular heart beat (75/min), crackles at both lung bases, and
major bilateral lower limb oedema (weight:+3kg)
• Biologically BNP was increased to 800.
• Heart Echography: reduced left ventricular ejection fraction
• Mr M. refused to be addressed in hospital and wished to be
managed at home by his family physician.
Questions:
• Do we insist by explaining and convincing Mr M to be
hospitalised (hopefully in cardiology bypassing the
emergency unit)?
Conditions associated with a poor prognosis in
heart failure
European Society of Cardiology, Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, et al. ESC Guidelines for
the diagnosis and treatment of acute and chronic heart failure 2008: Eur Heart J 2008;29(19):2388-442.
Questions:
• Are there some professional risk of litigation by managing
at home?
Questions:
• What is the optimal management organisation to set up?
- for the acute phase?
- for the follow up and rehabilitation phases?
Questions:
• What do we advocate for an ambulatory management of
difficult situations in Primary Care?
• How could we rethink our practices?
The End…
Thank you for your attention
The evidence base
-
European Society of Cardiology: Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski
P,and al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008:
European Heart Journal 2008;29(19):2388-442.
-
European Society of Cardiology: John J.V. McMurray, S. Adamopoulos, S. D. Anker, and all. ESC
Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: European Heart
Journal 2012; 33: 1787–1847.
-
Haute Autorité de Santé (french medical authority) : Heart Failure Recommendations