Out-of-hours primary care management for patients with heart failure

Area of Science:

• Cardiology
• Primary Care Medicine
• Emergency Medicine

Background:

• Management and disease trajectories of heart failure (HF) patients in pre-hospital settings are poorly understood.
• Shortness of breath (SOB) is a primary reason for out-of-hours primary care (OHS-PC) contact.

Purpose of the Study:

• To describe care trajectories of HF patients with SOB at OHS-PC.
• To assess 6-month mortality and hospital admission outcomes for these patients.

Main Methods:

• Retrospective analysis of 102 HF patients contacting Dutch OHS-PC for SOB (Sept 2020 - Aug 2021).
• Descriptive analyses of patient characteristics and care pathways.
• Comparison of outcomes for patients referred to the Emergency Department (ED) versus those managed in primary care.

Main Results:

• 102 HF patients (mean age 79.6 years, 53% women) accounted for 5.1% of SOB calls.
• 90.2% were initially managed in primary care, with 44.6% subsequently referred to the ED.
• 6-month all-cause mortality was 32.3%; 82.4% of ED-referred patients were admitted.

Conclusions:

• One in 20 OHS-PC contacts for SOB involves an HF patient with significant 6-month mortality risk.
• Management strategies included direct hospital referral or initiation/up-titration of loop diuretics.
• Further research into optimal pre-hospital HF management is warranted.