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

Abstract

Introduction: Little is known about the management and disease trajectories of heart failure (HF) patients in the pre-hospital setting when experiencing exacerbating symptoms. Shortness of breath (SOB) is a main reason for contacting out-of-hours primary care (OHS-PC). We aim to describe the care trajectories of these patients with HF at the OHS-PC with exacerbating symptom SOB and to assess 6-month outcomes regarding mortality and hospital admissions. Methods: We included patients who contacted Dutch OHS-PC for SOB between September 2020 and August 2021. We selected those in whom HF was considered to be the cause for consultation and further clinical evaluation. We applied descriptive analyses to characterize these patients and their disease trajectories following this OHS-PC contact and compared patients referred to the Emergency Department (ED) to those who remained in primary care. Results: Of 1833 calls for SOB, 102 (5.1%) concerned patients with HF, who had a mean age of 79.6 ± 11.1 years, and 53% were women. Ten (9.8%) patients were directly referred to the ED. The remaining 92 (90.2%) were first assessed by a general practitioner (GP): 62 (60.8%) received a home visit, 15 (14.7%) were seen at the OHS-PC clinic, and 15 (14.7%) received a telephone advice only. Of these 92 patients, 41 (44.6%) patients were subsequently referred to the ED, and 39 (42.4%) were kept at home and received loop diuretics (newly initiated or increased dose). Of the 51 patients referred to the ED (directly or after assessment with the GP), 42 patients (82.4%, P-value < .001) were admitted. Six-month all-cause mortality of the 102 patients was 32.3%. Conclusion: At the OHS-PC, one in every 20 contacts for SOB is a HF patient who has a high 6-month mortality risk. Patients were directly referred to the hospital or received initiation or up-titration of loop diuretics.