Hello, I'm Guillaume Baudry. I'm a French cardiologist and I work in Nancy. And today we'll talk about the importance of the prognostic value of a simple stratification based on French heart failure log data.

What is the importance behind the trial?

This study is important because it's the first study to try to assess the association between cardiology follow up and prognosis in a nationwide cohort of heart failure patients. And so we show in this study that the follow up is not associated with severity of heart failure patients. And we also show that an increased follow up is associated with improved prognosis in a nationwide cohort of heart failure patients.

What was the study design and patient population?

So study population include all heart failure patients selected with a long-term heart failure condition or a heart failure hospitalisation between 2014 and 2019, and patients were alive at January 1st 2020, which is the start of the follow up.

It's a study based on the French health insurance database and all patients were included. And we look on the healthcare consumption in heart failure patients in France. So we look the cardiology consultation but also the medication and we're interested in heart failure hospitalisation, all-cause mortality and the composite outcome.

What were the key outcomes, and were there any surprising or unexpected results?

The key outcome in this cohort study was that 25 to 35 patients don't have a consultation in 2019. And if we continue follow up in 2020, almost 40% of patients don't have at least one cardiology consultation.

In a second, we also show that follow up was associated with an improving prognosis and for one consultation there is a risk reduction of 25% of mortality, but if you increase to four consultations, there is a decrease to 40% risk of all-cause mortality.

So we try to do some some modelling and we show that the optimal number of consultations was one consultation for the low-risk group, two to three consultations for the intermediate group and four consultations for the high-risk groups.

We stratify our heart failure population in four groups: patients with a hospitalisation prior year, patients hospitalised one to five years ago, patients with no hospitalisation but loop diuretics and patients without diuretics. And we show that to have a follow-up stratify according to this risk stratification is really important.

How might this stratification model influence clinical decision-making?

I think the use of this very simple and always available classification is very important to adapt the follow up. And using modelling we show that if you use at least one consultation for whole patient, you need to see only 16 patients to avoid one modeling death at one year.

To improve prognosis in more severe populations, it's really important to adapt follow up to the stratification severity. And in whole modelling we show that for the low severity group, only one consultation is sufficient, but if you want to improve prognosis, it's more severe strata. The best solution is to see patients two to three times for the two intermediate groups and at least four times for the high-risk group.

What are the next steps?

All our data, I hope, are rational. So the next step is to do some interventional study showing that adapting the cardiology follow up according to heart stratification could improve prognosis of heart failure patients.