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Primary Care

Doctors' perceptions of palliative care for heart failure: focus group study

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7364.581 (Published 14 September 2002) Cite this as: BMJ 2002;325:581

Heart Failure and palliative management

To the editor: We read with interest the paper by Hanratty et al., on
doctor’s perception of palliative care for heart failure HF) and we would
like to make some comments.

The first concerns the definition of terminal care itself: when patients
have to switch from ordinary clinical to palliative care? Isn’t there a
risk of precocious withdrawal of useful treatments due to the
unpredictable course of heart failure? What about patients’ wishes and
preferences?

Secondarily, while in palliative care for cancer patients we
follow precise guidelines, what about pharmacological and non
pharmacological interventions when a HF patient enters a palliative care
program? Even the enhanced role for nurses could be ambiguous, if it is
not clear the role of physicians (hospital doctors and family
practitioners), since they could be induced to delegate the decisions for
important treatment choices.

In contrast with the model proposed by the focus group study we think that
continuity of care is the best answer to the need of patients. In this
light we would like to discuss our model of guiding the long term care of
patients through a careful information of family practitioners and a
continuos contact with patients and their caregivers, without a palliative
care program.

In a group of 149 HF patients (NYHA classes III-IV) we observed a 33.6%
mortality at 6-months; of these 10 patients died in-hospital (6.7%).
Blindly reviewing the discharge charts of the 139 discharged patients we
were unable to predict a short term risk of death and the consequent need
for palliation.

In conclusion we think that in the Italian NHS a compromise could be the
best answer to HF patients needs, i.e. an informal follow-up by hospital
doctors in strict relationship with general practitioners and the family
for the entire natural history.

Competing interests: No competing interests

23 September 2002
Renzo Rozzini
Poliambulanza Hospital&GRG
Tony Sabatini and Marco Trabucchi
Via Bissolati 57, 25124 Brescia (Italy)