title: Palliative needs for heart failure or chronic obstructive pulmonary disease: Results of a multicenter observational registry.
abstract: BACKGROUND
  Heart failure (HF) and chronic obstructive pulmonary disease (COPD) share a common organ failure trajectory marked by prognostic uncertainty, which is a barrier to appropriate provision of palliative care. We describe in a prospective cohort from specialist hospital services the epidemiology and late clinical course of these chronic diseases to trace criteria for transition to palliative care in the community.
  
  
  RESULTS
  Seven centers enrolled 267 patients with advanced HF (n=174) or COPD (n=93) using common (multiple hospitalizations or severely impaired functional status or cachexia) and disease-specific (HF: systolic dysfunction, NYHA classes III-IV, end-organ hypoperfusion; COPD: very severe airflow obstruction, hypoxemia, hypercapnia, or long-term oxygen therapy) entry criteria. These patients represented 7.2% and 13% respectively of the overall HF and COPD population hospitalized during one year. They showed similar symptom burden, functional and quality of life impairment, recurrent hospitalizations, and 6-month mortality (39% and 37%, respectively). Organ failure progression was the cause of death in >75%. In-hospital overall stay during the previous year was the main mortality predictor in both. Disease-specific predictors included anemia, hyponatremia, no beta-blockers in HF; older age, hypercapnia in COPD.
  
  
  CONCLUSIONS
  Patients with advanced HF/COPD represent almost 10% of subjects hospitalized yearly with a primary diagnosis of HF or COPD, have similarly impaired functional status, disabling symptoms and reduced survival. Overall days spent in-hospital during the previous year, a "red flag" in the late clinical course of both diseases, might be used as a simple, reliable screening tool for appropriate transition to palliative care in the community.
authors.affiliation: FROM Research Foundation, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy. Electronic address: agavazzi@hpg23.it.
authors.forename: Antonello
authors.initials: A
authors.lastname: Gavazzi
authors.affiliation: Istituto di Fisiologia Clinica CNR, Dipartimento Cardiotoracovascolare, Azienda Ospedaliera Ospedale Niguarda-Ca' Granda, Milano, Italy.
authors.forename: Renata
authors.initials: R
authors.lastname: De Maria
authors.affiliation: Dipartimento di Medicina e Scienze dell'Invecchiamento, Università G. D'Annunzio, Chieti, Italy.
authors.forename: Lamberto
authors.initials: L
authors.lastname: Manzoli
authors.affiliation: Divisione di Cardiologia, Ospedale San Salvatore, Pesaro, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bocconcelli
authors.affiliation: Servizio di Cure Palliative, Ospedale Salvini, Garbagnate, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Leonardo
authors.affiliation: Dipartimento Cardiotoracovascolare, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milano, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Frigerio
authors.affiliation: Divisione di Pneumologia, Ospedali Riuniti, Ancona, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Gasparini
authors.affiliation: Centro Cardiovascolare, Azienda Sociosanitaria 1 Triestina, Trieste, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Humar
authors.affiliation: Dipartimento di Scienze Cardiologiche Medico-Chirurgiche, Ospedali Riuniti, Ancona, Italy.
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Perna
authors.affiliation: Divisione di Cardiologia, Ospedale San Luigi Gonzaga, Orbassano, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Pozzi
authors.affiliation: Direzione Sanitaria, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Svanoni
authors.affiliation: Divisione di Pneumologia, Ospedale San Salvatore, Pesaro, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Ugolini
authors.affiliation: Area Governo Clinico, Agenzia Regionale Sanitaria Regione Marche, Ancona, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Deales
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010166:Palliative Care / Q000379:methods / Q000706:statistics & numerical data; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D011788:Quality of Life; D012042:Registries; D012720:Severity of Illness Index
keywords: Advanced chronic obstructive pulmonary disease; Advanced heart failure; Mortality; Palliative care; Quality of life; Symptom burden