General practitioners often provide primary palliative care for advanced heart failure, while over 50% of cardiologists rarely manage symptoms or refer to specialist palliative care.
How do self-reported palliative care provision practices for advanced heart failure patients differ between office-based cardiologists and general practitioners in Germany?
In the out-of-hospital setting in Germany, primary palliative care for advanced heart failure is frequently provided by GPs but rarely by office-based cardiologists, indicating underutilization of these services.
Abstract Background Palliative care should be part of the standard management for advanced heart failure. However, it remains unclear how palliative care is currently delivered to patients with advanced heart failure in out-of-hospital settings in Germany. Purpose To study the self-reported palliative care provision practices of office-based physicians in Germany. Method We conducted a nationwide survey among office-based cardiologists and general practitioners (GPs) on how they provided palliative care for patients with advanced heart failure during the past 12 months. The survey was developed by a multiprofessional project group of the German Society for Cardiology and Cardiovascular Research (DGK e.V.) and administered online by the German Association of Office-based Cardiologists (BNK e.V.). Subgroups were compared using the Chi-square test. Results A total of 235 physicians participated in the survey (146 cardiologists, 89 GPs), of whom 25% were women. All of them reported that they had cared for patients with advanced heart failure during the passt 12 months. A majority of respondents reported frequently or always discussing prognosis and treatment goals with advanced heart failure patients (Figure 1). Primary palliative care, such as comprehensive symptom management, psychosocial support, and end-of-life care, was provided often or always by a vast majority of GPs. Over half of office-based cardiologists, however, reported rarely or never comprehensively managing physical and/or psychological symptoms (Figure 1). Referral to home-based specialist palliative care services was also much more often initiated by GPs (p0.001). Conclusion In the out-of-hospital setting, primary palliative care for patients with advanced heart failure is provided often by GPs but only rarely by office-based cardiologists. Home-based specialist palliative care services appear underutilised in advanced heart failure.
Blum et al. (2025) studied this question. General practitioners often provide primary palliative care for advanced heart failure, while over 50% of cardiologists rarely manage symptoms or refer to specialist palliative care.
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