title: Palliative care among heart failure patients in primary care: a comparison to cancer patients using English family practice data.
abstract: BACKGROUND
  Patients with heart failure have a significant symptom burden and other palliative care needs often over a longer period than patients with cancer. It is acknowledged that this need may be unmet but by how much has not been quantified in primary care data at the population level.
  
  
  METHODS
  This was the first use of Clinical Practice Research Datalink, the world's largest primary care database to explore recognition of the need for palliative care. Heart failure and cancer patients who had died in 2009 aged 18 or over and had at least one year of primary care records were identified. A palliative approach to care among patients with heart failure was compared to that among patients with cancer using entry onto a palliative care register as a marker for a palliative approach to care.
  
  
  RESULTS
  Among patients with heart failure, 7% (234/3 122) were entered on the palliative care register compared to 48% (3 669/7 608) of cancer patients. Of heart failure patients on the palliative care register, 29% (69/234) were entered onto the register within a week of their death.
  
  
  CONCLUSIONS
  This confirms that the stark inequity in recognition of palliative care needs for people with heart failure in a large primary care dataset. We recommend a move away from prognosis based criteria for palliative care towards a patient centred approach, with assessment of and attention to palliative needs including advance care planning throughout the disease trajectory.
authors.affiliation: Palliative Medicine, Hull York Medical School, University of Hull, Hull, East Yorkshire, United Kingdom.
authors.forename: Amy
authors.initials: A
authors.lastname: Gadoud
authors.affiliation: Department of Health Sciences, University of York, York, North Yorkshire, United Kingdom.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Kane
authors.affiliation: Primary Care Medicine, Hull York Medical School, University of Hull, Hull, East Yorkshire, United Kingdom.
authors.forename: Una
authors.initials: U
authors.lastname: Macleod
authors.affiliation: Department of Health Sciences, University of York, York, North Yorkshire, United Kingdom.
authors.forename: Pat
authors.initials: P
authors.lastname: Ansell
authors.affiliation: Population Health, Department of Health Sciences and Hull York Medical School, University of York, York, North Yorkshire, United Kingdom.
authors.forename: Steven
authors.initials: S
authors.lastname: Oliver
authors.affiliation: Palliative Medicine, Hull York Medical School, University of Hull, Hull, East Yorkshire, United Kingdom.
authors.forename: Miriam
authors.initials: M
authors.lastname: Johnson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004739:England; D005194:Family Practice; D005260:Female; D006333:Heart Failure / Q000451:nursing*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000451:nursing*; D010166:Palliative Care; D011320:Primary Health Care