Primary care patients with heart failure in the last year of their life

Abstract

Background: Quantitative information about the management of patients with advanced heart failure (HF) is scarce. Objective: To assess the management of primary care patients with HF in their last year of life. Methods: A retrospective observational study performed in 23 general practices in the Netherlands. The medical records of 399 patients with a diagnosis of HF and who died between 2001 and 2006 were scrutinized to review treatment and care in the year preceding death. Results: The mean age at death was 82.3 (SD 8.8) years, and the median time between diagnosis and death was 48 months (range 3-285 months). In total, 55.9% died at home or home for the elderly, 32.6% in hospital and 11.5% in a nursing home or hospice. The mode of death was in 28% sudden death, in 23% progressive HF and in 49% others. During the last year of life, patients on average visited 0.4 times the cardiology outpatient clinic and needed on average 12.1 (range 0-53) home visits of the GP. At the end of life, 35% of all the patients received opioids, 7% haloperidol, 7% oxygen and 5% diuretics intravenously. Patients co-treated by a cardiologist received similar care, however, they used more HF drugs than patients managed solely by the GP.Conclusions: A minority of patients with advanced HF have a terminal phase and died of progressive HF. In the last year of life, the GP is the main provider of care. © The Author 2011. Published by Oxford University Press. All rights reserved.