title: [Healthcare delivery to patients with heart failure: from healthcare networks to management of end-stage disease].
abstract: In geriatrics, end-stage chronic heart failure, old age and death are often an almost obliged clinical and existential continuum. Accompanying these patients to death with dignity and relief is an issue deserving a high degree of cultural attention not only by our discipline, but also by all other specialties and scientific societies that are devoted to the management of terminal illness. Involved professionals are too often in troubles in identifying the conditions that mark the boundary between continuing or stopping the specific treatments. Management of terminal illness requires the ability to identify and treat the complexity of patient's frailty; to discern when continuing therapy is still appropriate; to prepare young physicians in the soft communicative modalities needed to cope with such delicate problems; to face with patient's family expectations in front of death. It is also necessary to distinguish technocratic medicine from humanistic medicine, including human, cultural and overall coordinating capabilities and sharing these capabilities with all actors involved, focusing attention mainly on patient's dignity. Advanced or end-stage chronic heart failure is a peculiar clinical arena that requires close interaction among hospitals, outpatient health district services, and families' needs, expectations and support. Multidimensional assessment teams, firstly introduced into daily clinical practice by geriatricians, address individualized choices and share part of knowledge with cardiology teams. Dichotomy and cultural and scientific debate between aggressive treatment and euthanasia should not prevent from discussing crucial issues such as therapy withdrawal.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cester
authors.forename: Moreno
authors.initials: M
authors.lastname: Scevola
authors.forename: Sandro
authors.initials: S
authors.lastname: Buoso
mesh_terms: D002309:Cardiology; D003142:Communication; D019468:Disease Management; D006333:Heart Failure; D006801:Humans; D010820:Physicians