Patients' adherence to optimal therapeutic, lifestyle and risk factors recommendations after myocardial infarction: Six years follow-up in primary care.

BACKGROUND: The 20% observed mortality within 5 years among survivors of myocardial infarction may be explained in part by non-adherence to the recommended treatment over the long term. MAIN OBJECTIVE: To investigate post-myocardial infarction patients' adherence to the therapeutic, lifestyle and risk factor control recommendations of the French health authority over 6 years. MATERIALS AND METHODS: A cohort of survivors of myocardial infarction established in Tours in 2009 was followed over 6 years. The general practitioner of the patients included in the first 1-year follow-up study was contacted to collect data on treatments, cardiovascular risk factors and lifestyle between January and June 2015. Data were described and compared with the recommendations and predictors of achieving all the recommended targets were determined. RESULTS: A total of 97 patients (52%) among the 185 patients who underwent a coronary angioplasty for MI were included at baseline. Treatment was adapted by the general practitioner on the advice on the cardiologist for 75% (73/97) patients, by both of them for 12% (12/97) and by the general practitioner alone for 7% (7/97) patients. Among the 97 initial patients, 62 were included in the final analysis at 6 years. Fatal events rate was 5% (5/97) at 1 year and 12% (11/91) at 6 years. Non-fatal events rate was 44% (43/97) at 6 months, 19% (17/91) at 1 year and 29% (18/62) at 6 years. Six years after the myocardial infarction, 6 (10%) patients achieved the recommended targets in terms of prescriptions of treatment, risk factors and lifestyle targets. Exposure to a cardiac rehabilitation program after a myocardial infarction was associated with long-term achievement of optimal therapeutic objectives (OR = 7.31 [95% CI 1.74; 44.88], p<0.002). CONCLUSION: Our data show suboptimal long-term adherence to secondary prevention treatment in this high-risk population of survivors of myocardial infarction, which seems to be improved in patients exposed to a cardiac rehabilitation program.

2018 update of French recommendations on the management of postmenopausal osteoporosis.

OBJECTIVES: To update the 2012 recommendations on pharmacotherapy for postmenopausal osteoporosis, under the aegis of the Bone Task Force of the French Society for Rheumatology (SFR) and of the Osteoporosis Research and Information Group (GRIO), in collaboration with scientific societies (Collège national des généralistes enseignants, Collège national des gynécologues et obstétriciens français, Fédération nationale des collèges de gynécologie médicale, Groupe d'étude de la ménopause et du vieillissement hormonal, Société française de chirurgie orthopédique, Société française d'endocrinologie, and Société française de gériatrie et de gérontologie). METHODS: Updated recommendations were developed by a task force whose members represented the medical specialties involved in the management of postmenopausal osteoporosis. The update was based on a literature review and developed using the method advocated by the French National Authority for Health (HAS). DISCUSSION AND CONCLUSION: The updated recommendations place strong emphasis on the treatment of women with severe fractures, in whom the use of osteoporosis medications is recommended. All the available osteoporosis medications are suitable in patients with severe fractures; zoledronic acid deserves preference as the fist-line drug after a hip fracture. In patients with or without non-severe fractures, the decision to use osteoporosis medications is based on bone mineral density values and in challenging cases, on probabilities supplied by prediction tools such as FRAX®. All osteoporosis medications are suitable; raloxifene should be reserved for patients at low risk for peripheral fractures. The fracture risk should be reevaluated every 2 to 3 years to decide on the best follow-up treatment. These updated recommendations discuss the selection of first-line osteoporosis medications and treatment sequences.

[Guidelines and practices for type 2 diabetes. Patients' and doctors' preconceptions prevent effective patient education]. / Ecarts entre le référentiel et la pratique dans le diabète de type 2. Les préjugés des médecins et des patients sont un obstacle à une éducation efficace des patients.

BACKGROUND: Health insurance data show that general practitioners (GPs) do not strictly apply clinical practice guidelines for the management of patients with type 2 diabetes. METHOD: The Health insurance fund of the Centre region assessed doctors' practices in diabetes management and found sharp disparities. Our study sought to explain these differences by questioning (through interviews and questionnaires) a cross-section of GPs and patients with diabetes. RESULTS: Interviews and questionnaires show that doctors are well aware of the recommendations for follow-up and generally agree with them. Their systematic application, however, runs up against the concrete conditions of daily practice, especially in terms of diabetes education. CONCLUSION: GPs see the management of patients with diabetes as a combination of their own skills (decisions and advice) and of responsible patient behavior. Our results, however, suggest that GPs fail to counsel their patients properly because they cannot communicate to their patients the importance of diet and physical activity. Optimum management requires that doctors develop a cooperative relation with other health professionals and improve the patient-doctor relation to promote patients' understanding of the principles of their treatment and help them to accept responsibility for managing their disease.