Quality of acute heart failure treatment in France: Data from REseau Nord-Alpin des Urgences (RENAU).

BACKGROUND: Although mortality due to acute heart failure has decreased, its prevalence in France is still high. The aim of this study was to examine the quality of acute heart failure treatment in French emergency departments (EDs) with reference to subsequently published European Society of Cardiology (ESC) recommendations. METHODS: The medical records of patients with acute pulmonary oedema (as a marker for acute heart failure) admitted to the EDs of 11 French hospitals in 2013 were reviewed retrospectively. RESULTS: A total of 834 patients were included (median [interquartile range] age 84 [78-89] years; 48.6% male). Rates of compliance of initial management in 2013 to subsequently published 2015 recommendations were as follows: (1) thoracic ultrasound was performed in 17.3%; (2) loop diuretics were given in 75.9%; at a correct dose (among those for whom this was calculable) in 40.0% (3); intravenous nitrates were given in 21.7% of patients with systolic blood pressure>110mmHg; (4) non-invasive ventilation was initiated in 22.0% of patients with respiratory distress. Discharge summaries most often lacked a scheduled cardiologist follow-up (89.4%) and discharge patient weight (78.9%). CONCLUSIONS: The early management of patients with acute pulmonary oedema (as a marker of acute heart failure) in France in 2013 was quite different to recommendations published in 2015. A programme to implement the new recommendations is in place, and a repeat evaluation will be conducted in 2017.

Treatment of acute cardiac failure in the emergency department. Improve our practices? Data from the RESURCOR network.

BACKGROUND: In 2015, the European Society of cardiology published guidelines on the pre-hospital and early hospital management of acute cardiac failure (ACF), which included: - use of intravenous vasodilators (nitrates) when systolic blood pressure is>110mmHg; - non-invasive ventilation if oxygen saturation is<90% and/or respiratory rate is>25/min despite nasal oxygen; - using a reduced dose of intravenous furosemide (20-40mg or equivalent of the oral morning dose if already on chronic diuretic therapy) and; - early performance of echocardiography. We sought to compare the gap between these recommendations and clinical practices in French emergency departments (EDs). METHODS: We undertook a retrospective evaluation of clinical practices in 834 consecutive patients with ACF admitted in 2013 to the EDs of 16 French hospitals. Data, including patient characteristics and practices were collected from the medical records. RESULTS: Patients' mean±standard deviation age was 82±10 years and 49% were men. Clinical practices in relation to the guideline recommendations are shown in the Table 1. CONCLUSIONS: These initial data which precede publication of the current guidelines, show that use of nitrates, non-invasive ventilation, reduced diuretic dose and early echocardiography were relatively infrequent at the first point of medical care for patients presenting with ACF. These findings indicate the need for a sizable shift in practice in order to meet the new guideline recommendations. We will conduct a repeat evaluation in 2016, after implementation of a programme aimed to improve practices at these sites.

Cefaclor treatment of upper and lower respiratory tract infections caused by Moraxella catarrhalis.

A retrospective analysis of data from 18 clinical studies was performed to examine the effectiveness and safety of cefaclor in the treatment of upper and lower respiratory tract infections caused by Moraxella catarrhalis (previously called Branhamella catarrhalis). Eighty-six percent of 56 evaluable patients had improvement in their symptoms of infections following therapy with cefaclor. There were no serious or life-threatening adverse drug experiences reported by any patient. Cefaclor appears to be an appropriate antibiotic for the safe and effective treatment of respiratory tract infections caused by M. catarrhalis.

Concomitant administration of terazosin and atenolol for the treatment of essential hypertension.

The safety and efficacy of once-daily terazosin hydrochloride administered concomitantly with once-daily atenolol for the treatment of essential hypertension were evaluated in this double-blind, multiclinic, placebo-controlled study. After each patient received 50 mg of atenolol daily for eight weeks, patients with a supine diastolic blood pressure (DBP) of 95 to 110 mm Hg and whose supine DBP had decreased at least 5 mm Hg were randomized to receive either terazosin (plus atenolol) or placebo (plus atenolol) for ten weeks. Patients assigned to the terazosin hydrochloride treatment group received increasing dosages (1,2,5, and 10 mg daily) [corrected] of terazosin at two-week intervals until the maximum dose was reached or until the supine DBP was decreased to less than 90 mm Hg. Terazosin-treated patients (n = 43) had significant mean decreases from the baseline in supine BP (systolic/diastolic = -8.8/-8.5 mm Hg) and standing BP (-10.9/-9.5 mm Hg), whereas the decreases in BP in the placebo-treated patients (n = 49; supine, -2.3/-2.6 mm Hg; standing, -1.4/-1.3 mm Hg) were not significant. When terazosin and placebo were compared, the differences in BP were significant. Terazosin-treated patients had significantly greater decreases in mean percent change of total cholesterol (-4.8%) and low-density lipoprotein plus very-low-density lipoprotein cholesterol (-6.3%) levels, compared with the placebo-treated patients (+0.6% and +1.1%, respectively). Concomitant administration of terazosin and atenolol to patients with essential hypertension was found to be safe and efficacious.