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By: Dr. Laura Mantine
Love is all around this month, especially on Valentine’s Day, when we take time to turn to those closest to us and say those three magical words. However, if you have a loved one who suffers from advanced cardiac disease, one of the best ways to show how much you care may not come in a sentimental card or a box filled with chocolates. Instead, it may come from calling hospice. Oftentimes, people don’t realize that hospice care is an option for people who suffer from advanced cardiac disease. Instead, these patients often spend their final days and months in and out of the hospital, receiving treatments that do little to improve the course of the disease. Hospice offers a supportive program of holistic care designed to help patients manage symptoms, forego emergency room visits and receive convenient, compassionate care right in their places of residence.
The estimated annual cost of heart disease is about $200 billion each year. Heart disease is the leading cause of death in the United States across all demographics. Heart disease accounts for 17.8% of hospice deaths, second only to cancer (30.1%). During hospice care, cardiac patients are monitored by a team of physicians and nurses, who administer medications and treatments to keep them as comfortable as possible. Social workers can access valuable community resources. Chaplains and counselors provide emotional and spiritual care for the patient and family. Volunteers can sit with patients, read to them or help them with light household chores, and allow caregivers to get some much-needed respite.
End-stage heart failure is often marked by an abrupt, dramatic decline, followed by recurring recovery and stability until sudden death. Patients are ideal candidates for goals-of-care conversations when they have severe refractory heart failure or extensive symptoms of cardiac insufficiency, have tried or cannot tolerate maximum medical management and are not candidates for curative therapies or surgical interventions. Hospice care addresses a wide range of symptoms, including shortness of breath, chest pain, weakness and functional decline. Eligibility for hospice may require documentation of progressive loss of functional capacity over years, progressive failure to respond to therapies and a desire to discontinue curative treatment. Patients should check with their physician to see whether they are eligible for hospice based on their history of congestive heart failure, arrhythmias or heart attacks. The physician may also consider any coexisting diseases like HIV, diabetes, respiratory illness or kidney disease when transitioning a patient to hospice care.
In addition to increasing a cardiac patient’s quality of life, hospice often increases the cardiac patient’s quantity of life as well. In a study reported in the March 2007 Journal of Pain and Symptom Management, congestive heart failure patients who chose hospice survived 81 days longer than those who did not. Even when modern-day technology or surgery can no longer offer hope, patients with late-stage cardiac disease need to know that help is always available. Hospice allows these patients to experience as much joy as possible in their remaining days while minimizing their discomfort and pain.
Centers for Disease Control and Prevention, National Center for Health Statistics. (2016). Multiple Cause of Death 1999-2015 on CDC WONDER Online Database. Data are from the Multiple Cause of Death Files, 1999-2015, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program.
Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association. Circulation. 2017;135:e1–e458. DOI: 10.1161/CIR.0000000000000485.
National Hospice and Palliative Care Organization. (2018). NHPCO Facts and Figures 2018 edition.
Ziaeian, B., & Fonarow, G. C. (2016). The Prevention of Hospital Readmissions in Heart Failure. Progress in cardiovascular diseases, 58(4), 379–385. doi:10.1016/j.pcad.2015.09.004
By: Marisol Ramirez, RN
Every stage of life is important. Clinicians understand how to care for late-stage heart failure patients. Every minute of life is valued and deeply treasured, emphasizing our utmost commitment to providing the best expert care in the last moments of life that matter most. It is a great honor to be a part of vulnerable moments, provide expert care, and provide emotional support and guidance when deciding the best options for your loved one. Have you or someone you love been diagnosed with advanced heart disease? Has a physician suggested hospice care, but you are just not sure where to even begin searching for answers? In honor of World Heart Day, we’ve put together this guide to bring you clear answers that will allow you to make the best-informed decisions for you or your loved one.
Hospice care is specifically designed with the patient and family in mind. Ensuring patients are safe in their homes, comfortable, and pain-free is essential. Comprehensive hospice services are essential to satisfy the patients’ and their families’ most pressing needs.
You may find yourself in need of expert clinicians and skilled nurses to help you manage your heart failure, help with pain control, and preserve a sense of normalcy during the last months of life. Know that your hospice team is here for you and your loved ones.
Patients on hospice services have less than six months of life remaining. This may be the most difficult decision you will ever need to make, but you do not have to go through the process alone. Invite your family and special people in your life to provide support and be present when discussing options with your physician.
Your hospice team can support you in educating your loved ones on the disease process and can provide support during this time.
Recognizing the signs and symptoms of end-stage heart failure is critical. According to the American Heart Association, end-stage heart failure is when most treatments may no longer work and when the patient experiences more frequent symptoms.
Frequent and recurring angina, or chest pain, is common at end-stage heart failure. It may become more difficult to breathe, in addition to feeling short of breath with minimal exertion or at rest. Your doctor may recommend supplemental oxygen to alleviate the strain, or medications to relieve chest pains or heart palpitations.
According to a Heart.org study, medical records of patients with end-stage heart failure tend to have symptoms very similar to patients with cancer:
Other common symptoms to note that may affect daily functions:
In addition to the cardiac insufficiency, these symptoms may cause patients to feel overly fatigued and with less energy to complete their normal functions of daily living. Patients may require more hands-on care from their caregivers or family at this time. This may include performing tasks such as bathing, dressing, and grooming care.
There may come a point – even before the last six months of life prognosis – in which patients may come to terms with their end-stage heart failure diagnosis. They may have already decided that they will not consent to further medical interventions if it causes more pain or a poor quality of life. The patient’s loved ones must be present with kindness, support, and respect for the patient’s decisions. The patient’s decision to refuse further medical treatment can often bring discord from family members.
The nature of end-stage heart failure is complex. It involves providing support both for the patient and their families during their most vulnerable moments.
Hospice services provide an array of benefits for patients with advanced heart disease:
If you think you may benefit from the following services below, then hospice care may be for you.
Every patient is unique and will present different needs towards their end-of-life care. Your case manager will create your hospice plan of care to suit your needs, preferences, and health goals.
Competent healthcare professionals and physicians are on staff to specifically address your concerns, signs and symptoms, physical discomforts, and other medical questions you may have. On-call staff are available around the clock to support you to ensure you receive the best possible medical care in the comfort of your home.
Our hospice care team is committed to providing patients and families with the emotional and spiritual support they need.
Our hospice team’s goal is to relieve the patient’s pain and suffering, prevent complications, ensure safety in the patient’s surroundings, and provide education regarding end-of-life best practices. Our hospice services ensure that you or your loved one will receive the following:
Your care team may offer continuous care for up to 24 hours if the patient requires close monitoring or interventions due to a severe problem or health crisis.
A team of expert and compassionate professionals conduct regular home care visits. The goal is to help in alleviating symptoms, pain control, and educating patients and their families.
Providing the best possible experience at this stage of life is important. Our team understands that patients need to obtain the proper medical equipment and medical supplies, as related to the primary diagnosis.
Inpatient care is critical during those moments when extra help is needed to control pain or other symptoms. A short-term inpatient stay will be available in such cases.
The absence of proper end-of-life planning for families can be even more difficult when losing a loved one. Ultimately, hospice means:
Care at home requires a team effort and collaboration from the various parties involved. However, everyone knows that the patient’s family at the bedside is generally the one most involved physically and emotionally in the care of their ill loved one. Hospice provides families up to five days of inpatient respite services. This gives caregivers and family a much-needed break during this time.
Hospice providers understands that death is a life-changing moment for the survivors. Hospice provides bereavement services for the family to provide care and support after a loved one’s death.
Often, hospice accepts Medicare, Medicaid, private insurance, and other forms of payment. You may contact your local hospice branch to find out more about hospice services and insurance questions.