Deaths from heart failure in general practice: implications for palliative care.

Trial and observational research indicates a high one-year mortality with a significant potential for specialist palliative care for patients with heart failure. A community observational study was undertaken in two general practices, with a total population of 21,000. There were three objectives: to determine the prevalence of symptomatic heart failure, to document mortality in the cohort over six and 12 months, and to establish the population in which a palliative care approach was adopted. A search of the computerized medical records yielded 548 patients with symptomatic heart failure (2.6% of the total study population). Over a six-month period, 31 patients (6% of the cohort) died and over a 12-month period 64 patients (12% of the cohort) died. 'Sudden death' was recorded in the records of 14 patients and death from coexisting malignancy was recorded in seven patients. A palliative care approach in patients not dying suddenly or of malignancy was recorded in 21 cases (33% of the total deaths). The findings do not indicate a high mortality in patients with symptomatic heart failure in general practice. The role of specialist palliative care in many cases would appear to be limited by the difficulty in predicting prognosis. In a significant number of cases, general practitioners appear to be aware of the need for a palliative care approach in patients dying of heart failure.