LAUSR

Objectives: HF is one of the leading causes of hospitalization in France for patients above 65 years old and represented a cost of 2 3 billion for the national health insurance in 2017 The objective is to describe heart failure (HF) patient pathway and identify breaking points that could be improved in France Methods: Descriptions were based on a literature review and qualitative interviews conducted with different stakeholders including cardiologists, geriatrician, general practitioners, nurses, pharmacists, patient associations and regional health agencies Results: The management and coordination of the patient's care pathway is complex and burdened with frequent and prolonged rehospitalizations Multiple breaking points have been identified in the patient pathway as a late therapeutic management of symptoms, a therapeutic inertia, scarce medical and paramedical resources limiting their ability to get involved in therapeutic education or a too narrow link between inpatient hospitalizations and outpatient settings to ensure a strong continuity of care Different solutions have been implemented nationally or locally to improve the pathway by promoting the use of telemedicine, smart scale or optimizing therapeutic education for HF patients Although telemedicine has not had the success story it had hoped until recently, it seems that the COVID-19 has enable the rise of digital health solutions considered as an innovative and necessary alternative Conclusions: While the economic and clinical burden of HF continue to increase it is important to improve the care pathway in order to reduce the risk of re-hospitalizations and the associated costs Digital solutions including e-health and telemedicine could enable to improve the patient pathway