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EnglishBackground: 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. Methods and 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.
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| Data di pubblicazione: | 2015 | |
| Titolo: | Palliative needs for heart failure or chronic obstructive pulmonary disease: Results of a multicenter observational registry | |
| Autori: | Gavazzi, Antonello; De Maria, Renata; Manzoli, Lamberto; Bocconcelli, Paolo; Di Leonardo, Antonio; Frigerio, Maria; Gasparini, Stefano; Humar, Franco; Perna, Gianpiero; Pozzi, Roberto; Svanoni, Fausto; Ugolini, Marcello; Deales, Alberto | |
| Rivista: | INTERNATIONAL JOURNAL OF CARDIOLOGY | |
| Parole Chiave: | Advanced chronic obstructive pulmonary; Advanced heart failure; Disease; Mortality; Palliative care; Quality of life; Symptom burden; Aged; Aged, 80 and over; Chronic Disease; Female; Humans; Italy; Male; Middle Aged; Needs Assessment; Prognosis; Prospective Studies; Registries; Severity of Illness Index; Heart Failure; Palliative Care; Pulmonary Disease, Chronic Obstructive; Quality of Life; Medicine (all); Cardiology and Cardiovascular Medicine | |
| Abstract in inglese: | 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. Methods and 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. | |
| Digital Object Identifier (DOI): | 10.1016/j.ijcard.2015.03.056 | |
| Handle: | http://hdl.handle.net/11392/2360406 | |
| Appare nelle tipologie: | 03.1 Articolo su rivista |
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