title: 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.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht. f.h.rutten@umcutrecht.nl
authors.forename: Frans H
authors.initials: FH
authors.lastname: Rutten
authors.forename: Wendelien S
authors.initials: WS
authors.lastname: Heddema
authors.forename: Gerard J A
authors.initials: GJ
authors.lastname: Daggelders
authors.forename: Arno W
authors.initials: AW
authors.lastname: Hoes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care; D005260:Female; D058006:General Practice; D006299:Health Services for the Aged; D006333:Heart Failure / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008499:Medical Records; D009426:Netherlands / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies