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Specialist Advice Support for Management of Severe Hereditary Angioedema Attacks: A Multicenter Cluster-Randomized Controlled Trial
Bernard Floccard 1
Auteur
Gisele Kanny 2
Auteur Etablissement employeur : Université de Lorraine
Elinor Baker
Auteur
Ludovic Martin 3
Auteur
Eric Vicaut 4
Auteur
Frederic Adnet 5
Auteur
Nicolas Javaud 6
Auteur
Olivier Fain 7, 8, 9, 10
Auteur
Isabelle Durand-Zaleski 11
Auteur
David Launay 12, 13, 14
Auteur
Laurence Bouillet 15
Auteur
Anne Gompel 16, 17
Auteur
Frédéric Lapostolle 5, 18
Auteur
Isabelle Boccon-Gibod 19, 15
Auteur
Paul-Georges Reuter 20
Auteur
Philippe Bertrand 21
Auteur
Malha Mezaour 22
Auteur
Brigitte Coppere 1
Auteur
- HCL - Hospices Civils de Lyon (3 Quai des Célestins 69002 Lyon - France)
- UA - Université d'Angers : UMRS1083 UMR6015 (Université d'Angers - 40 Rue de Rennes, BP 73532 - 49035 Angers CEDEX 01 - France)
- INSERM - Institut National de la Santé et de la Recherche Médicale : UMR1083 (101, rue de Tolbiac, 75013 Paris - France)
- CNRS - Centre National de la Recherche Scientifique : UMR6015 (France)
- CHU Saint-Antoine [AP-HP] (184, rue du Faubourg Saint-Antoine
75571 Paris cedex 12 - France)
- AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) (France)
- Sorbonne Université (France)
- AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) (France)
- AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) (France)
- SU - Sorbonne Université (21 rue de l’École de médecine - 75006 Paris - France)
- CHU Saint-Antoine [AP-HP] (184, rue du Faubourg Saint-Antoine
75571 Paris cedex 12 - France)
- AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) (France)
- Sorbonne Université (France)
- SU - Sorbonne Université (21 rue de l’École de médecine - 75006 Paris - France)
- CHU Saint-Antoine [AP-HP] (184, rue du Faubourg Saint-Antoine
75571 Paris cedex 12 - France)
- AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) (France)
- Sorbonne Université (France)
- INSERM - Institut National de la Santé et de la Recherche Médicale : U938 (101, rue de Tolbiac, 75013 Paris - France)
- SU - Sorbonne Université (21 rue de l’École de médecine - 75006 Paris - France)
- CHRU Lille - Centre Hospitalier Régional Universitaire [Lille] : U995 (2, avenue Oscar Lambret - 59037 Lille Cedex - France)
- INSERM - Institut National de la Santé et de la Recherche Médicale : U995 (101, rue de Tolbiac, 75013 Paris - France)
- Université de Lille (Lille - France)
- Institut Pasteur de Lille : U995 (1 Rue du Professeur Calmette - Lille Cedex - 59019 - France)
- RIIP - Réseau International des Instituts Pasteur (25, rue du Dr Roux 75724 Paris Cedex 15 - France)
- CHRU Lille - Centre Hospitalier Régional Universitaire [Lille] (2, avenue Oscar Lambret - 59037 Lille Cedex - France)
- UJF - Université Joseph Fourier - Grenoble 1 (BP 53 - 38041 Grenoble Cedex 9 - France)
- CHU Grenoble (France)
- AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) (France)
- UPD5 - Université Paris Descartes - Paris 5 (12, rue de l'École de Médecine - 75270 Paris cedex 06 - France)
- Hôpital Hôtel-Dieu [Paris] (1, place du Parvis Notre-Dame 75004 Paris - France)
- Hôpital Avicenne [AP-HP] (125, rue de Stalingrad 93000 Bobigny - France)
- MASCOT (UMR_S_942 / U942) - Marqueurs cardiovasculaires en situation de stress (Hopital Lariboisière - Centre Viggo Petersen
41, Bd de la Chapelle
75475 Paris Cedex 10
- France)
- Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris] (200 rue du Faubourg Saint-Denis 75475 Paris (Nord) Cedex 10 - France)
- INSERM - Institut National de la Santé et de la Recherche Médicale : U942 (101, rue de Tolbiac, 75013 Paris - France)
- UP13 - Université Paris 13 (France)
- UP11 - Université Paris-Sud - Paris 11 (Bâtiment 300 - 91405 Orsay cedex - France)
- CNRS - Centre National de la Recherche Scientifique : UMR_S_942 (France)
- UPD7 - Université Paris Diderot - Paris 7 : UMR_S_942 (5 rue Thomas-Mann - 75205 Paris cedex 13 - France)
- UP11 - Université Paris-Sud - Paris 11 : EA 4532 (Bâtiment 300 - 91405 Orsay cedex - France)
- UO - Université d'Orléans : EA 4532 (Château de la Source - Avenue du Parc Floral - BP 6749 - 45067 Orléans cedex 2 - France)
STUDY OBJECTIVE: Hereditary angioedema is a rare disease associated with unpredictable, recurrent attacks of potentially life-threatening edema. Management of severe attacks is currently suboptimal because emergency medical teams are often unaware of new specific treatments. The objective of this trial is to test whether a dedicated national telephone care-management strategy would reduce resource use during severe hereditary angioedema attacks.
METHODS: We conducted a cluster-randomized multicenter prospective trial of patients with a documented diagnosis of hereditary angioedema (type I, II or FXII hereditary angioedema). Participants were enrolled between March 2013 and June 2014 at 8 participating reference centers. The randomized units were the reference centers (clusters). Patients in the intervention arm were given a national free telephone number to call in the event of a severe attack. Emergency physicians in the SOS-hereditary angiœdema (SOS-HAE) call center were trained to advise or prescribe specific treatments. The primary outcome was number of admissions for angioedema attacks. Economic evaluation was also performed.
RESULTS: We included 100 patients in the SOS-HAE group and 100 in the control group. During the 2 years, there were 2,368 hereditary angioedema attacks among 169 patients (85%). Mean number of hospital admissions per patient in the 2-year period was significantly greater in the usual-practice group (mean 0.16 [range 0 to 2] versus 0.03 [range 0 to 1]); patient risk difference was significant: -0.13 (95% confidence interval -0.22 to -0.04; P=.02). Probabilistic sensitivity graphic analysis indicated a trend toward increased quality-adjusted life-years in the SOS-HAE group.
CONCLUSION: A national dedicated call center for management of severe hereditary angioedema attacks is associated with a decrease in hospital admissions and may be cost-effective if facilities and staff are available to deliver the intervention alongside existing services.
Contributeur : Okina Université d'Angers <>
Soumis le : lundi 25 mai 2020 - 03:35:47
Dernière modification le : vendredi 11 juin 2021 - 13:20:05
Identifiants
- HAL Id : hal-02616882, version 1
- DOI : 10.1016/j.annemergmed.2018.01.053
- OKINA : ua19919
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UNIV-ANGERS | HCL | RIIP | HEH | U938 | UNIV-LORRAINE | UNIV-ORLEANS | UNIV-LILLE | SU-MEDECINE | CNRS | CARDIOVASCULAR-MARKERS-IN-STRESSED-CONDITIONS | SORBONNE-PARIS-NORD | UNIV-PARIS13 | UNIV-PARIS5 | UNIV-PARIS7 | UP-SANTE | MITOVASC | USPC | SORBONNE-UNIVERSITE | UNIV-PARIS | POLITIQUES-PUBLIQUES
