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  • Title: [Patients with heart failure in the last year of their life: the primary care perspective].
    Author: D'Ambrosio G, Filippi A, Battaggia A, De Maria R, Cricelli C.
    Journal: G Ital Cardiol (Rome); 2014 Oct; 15(10):569-76. PubMed ID: 25424021.
    Abstract:
    BACKGROUND: The care of end-stage patients with heart failure (HF) represents a substantial cost and a relevant workload for health professionals and caregivers. Studies performed in out-of-hospital settings are limited. We aimed to provide data about management in primary care and professional needs of general practitioners (GPs). METHODS: One hundred fifty-one GPs provided information about patients with HF who died (whatever the cause) in the previous 365 days: a) where they died, b) cause of death, c) number and cause of hospital admission, d) who was mainly in charge of the patient during the year preceding death, e) place where patients were mainly cared for, f) relevant diseases other than HF. GPs were also requested to express their personal opinion about their professional needs. RESULTS: GPs identified 245 patients (mean age 83.8 ± 8.76 years, range 48-103, 53.9% female). The place of death was hospital (46.5%), home (42.9%), nursing home (4.9%), hospice (1.6%). Fifty percent of patients died of worsening HF, 14% of sudden death, 23% of noncardiovascular diseases. In the last year of life, 193 (78.8%) patients were hospitalized, 149 (60.8%) for HF. GPs were responsible for care in the majority of patients. Total number of hospitalizations was the only variable significantly associated with death in hospital. GPs reported clinical or organizational problems in 58.4% of cases. CONCLUSIONS: The care of HF patients is mostly home-based and provided by families and GPs. GPs often need simple and inexpensive cardiological and organizational support.
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