Care projects

• Study of cardiac insufficiency
• Detection and treatment of hyperglycaemia
• Follow up of obese patients after bariatric surgery
• Development of a cardiovascular prevention service

Study of cardiac insufficiency

Patient census
The cardiology service has set up a census of patients suspected of having cardiac deficiency during their admission to the CHUV. Initially it is a question of determining the epidemiological characteristics of the patients and following their evolution in hospital. All the investigations and treatment on leaving hospital are indexed and analysed.  The patients are then contacted by telephone six or twelve months later to evaluate their clinical situation at home.

The analysis of all these elements permits the determination of the etiologic diagnosis; the risk of aggravated cardiac insufficiency among these patients or the necessity for hospitalisation. This analysis should allow an optimisation of hospital and ambulatory care and improve their medical treatment.

Definition of responsibility
As the number of patients affected by this condition will increase as the population ages, the Cardiology Service will be confronted in the near future with an increase in hospitalisations. It seems indispensable to better define this population, both its medical situation as well as well as the necessary care.  This would allow the definition of forthcoming needs of patients within ambulatory care in cooperation with the medical practitioners.

Such an organisation has begun to be set up in Switzerland with the collaboration of the Swiss Cardiology Society, the Swiss Internal Medical Society and the Swiss General Medicine Society.

Dr Charles Seydoux, Cardiology Service

Detection and treatment of hyperglycaemia

Until recently, hyperglycaemia was considered in the hospital environment as a metabolic anomaly of no importance in the context of acute infections. Recently numerous studies have how shown that:

• that the incidence of hyperglycaemia  is high;
• that hyperglycaemia is associated with a significantly higher morbidity and mortality rate.

Within the CHUV, the intra-hospital mortality rate is 24% among patients admitted for acute coronary syndrome and 3% among patients admitted with normal glycaemia. Another study released in 2006, with the Cardiovascular Surgery Service, shows that glycaemia on the first post operation day was a predictive factor for morbidity and mortality and that it was associated with a prolonged stay in hospital.

From the therapeutic angle, numerous studies carried out in intensive care, the surgery and medical services have shown that a more strict check of glycaemia significantly reduces morbidity and mortality rates.

The objective of this project is to implement efficient management of hyperglycaemia in intensive care within CardioMet and then all the Hospice-CHUV institution.

The expected results are better expertise in management of hyperglycaemia and a reduction of the morbid-mortality rate.  Algorithms for checking glycaemia by insulin treatments will be introduced, taught and evaluated.

The services concerned: Only the Internal Medical Service is concerned in the first phase. The project will be progressively extended to the whole institution.

The planning: The project will began January 2007 and will continue for 2 years, when the consolidation phase will start.

Dr Juan Ruiz, Endocrinology, Diabeteology, and Metabolism Service

Follow up of obese patients after bariatric surgery

Obesity and nutrition are the two most important risk factors for cardiovascular and metabolic pathologies. In fact the majority of patients who are overweight have one or several co-morbidities or the actual pluri-metabolic syndrome. The dramatic increase in obesity and the inefficiency of so-called conserving treatments have given bariatric surgery a more and more important role in the care of obesity cases. This is why support will be given to the CardioMet project.

Lausanne has become the reference centre for this subject.  A romand network has been developed in this area. Since several years, surgical treatment is routinely proposed at the rate of 100 interventions per year. The database is a collection of more than 900 patients. Numerous publications have been produced.  It is necessary to improve the metabolic and nutritional follow-up of these patients to standardise it.  Many course modules are proposed to patients before and after interventions.

These developments have occurred within the collaboration framework between the CHUV services and the Physiology Department of the FMB. The services involved in the CHUV are mainly endocrinology, diabeteology, and metabolism.

A project is being developed within CardioMet; it will aim at standardising care, developing and facilitating the register and database, to strengthen the team, mainly at the level of a nutritionist as well as increasing the visibility of this excellent care service.

Dr Giusti, Endocrinology. Diabeteology and Metabolism Service.

Development of a cardiovascular prevention service

Context and unexpected results
Numerous studies have shown that the quality of secondary prevention of cardiovascular diseases is far from being optimal, in spite of its obvious benefits.  Treatments with proven results are under-used and patient information is insufficient to encourage healthy lifestyle behaviour.

The treatment of risk factors are often not initiated during hospitalisation although it is known that this is the opportune moment to assist patients in changing behaviour, such as giving up smoking.  This situation is mainly due to the priority given to intensive care and to lack of time for the nursing staff.  Studies of the implementation of cardiovascular prevention in hospitals have shown a significant reduction in secondary heart attacks, re-hospitalisation and mortality.

Objectives
The objective is to supply cardiovascular prevention consultations to all the CHUV services for patients hospitalised with acute or chronic cardiovascular diseases or multiple risk factors. The proposed interventions are health consultations and awareness information about the disease, patient education and medical advice.

Units concerned
All units involved in the care of these hospitalised patients are concerned.  The consultation is carried out in collaboration with the services involved with cardiovascular prevention and the staff caring for these patients.

Planning
A one-year pilot phase was carried out.  The evaluation by 50 doctors showed that the results were extremely satisfactory.  The availability of the cardiovascular prevention consultation is therefore going to be extended to all services.  An evaluation protocol of the satisfaction of the patients and their evolution after leaving hospital will also  be established.

Dr Nicolas Rodondi and Prof Jacques Cornuz, University Medical Polyclinic