• Antonello Gavazzi, Renata De Maria, Lamberto Manzoli, Paolo Bocconcelli, Antonio Di Leonardo, Maria Frigerio, Stefano Gasparini, Franco Humar, Gianpiero Perna, Roberto Pozzi, Fausto Svanoni, Marcello Ugolini, and Alberto Deales.
• FROM Research Foundation, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy. Electronic address: agavazzi@hpg23.it.
• Int. J. Cardiol. 2015 Apr 1;184:552-8.

BackgroundHeart 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 ResultsSeven 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.ConclusionsPatients 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.Copyright © 2015. Published by Elsevier Ireland Ltd.

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