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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
A leading cause of death in the United States, sudden cardiac arrest claims the lives of more than 356,000 people each year. This includes 23,000 youth under the age of 18. It is a life-threatening health emergency in which the heart suddenly stops beating, and it can occur in people of any age, including those who appear to be otherwise in good health.
When a person goes into cardiac arrest, they collapse and do not respond or breathe normally. They may also gasp or shake, similarly to a seizure. It is critical that the person gets help immediately, as it can lead to death within minutes. With October being Sudden Cardiac Arrest Awareness Month, we want to help raise awareness and explain what it is and what you can do when someone experiences this medical emergency.
As previously mentioned, sudden cardiac arrest is a health emergency in which the heart suddenly stops beating. It is life-threatening, and survival depends on people nearby calling 911, as well as starting CPR and using an AED (if available) as soon as possible. An AED (automated external defibrillator) is a portable, electronic device that is used to help someone who is experiencing sudden cardiac arrest. It analyzes the heart’s rhythm and can deliver an electrical shock to help the heart re-establish an effective rhythm.
Sudden cardiac arrest is not the same as a heart attack. A heart attack is a blockage in coronary arteries that interrupts blood flow to the heart. The website stopcardiacarrest.org does a great job of explaining the differences between a heart attack and sudden cardiac arrest. It describes sudden cardiac arrest as being electrical and a heart attack as being plumbing.
To summarize the differences between the two, someone experiencing sudden cardiac arrest is unresponsive and not breathing, and they may gasp or shake. It can happen to anyone of any age, and people nearby must start CPR immediately to increase the likelihood of survival.
In contrast, someone experiencing a heart attack may experience pain in their chest, neck, or left arm. They may also experience shortness of breath, sweating, or nausea. A heart attack most often occurs in people over the age of 65, and responsive victims do not need CPR.
However, you should call 911 for someone experiencing either.
Cardiac arrest happens suddenly so it’s important that you know what to do so you can act quickly if you are nearby when it occurs. So what do you do when someone is suddenly unresponsive and breathing abnormally or gasping for air? According to the American Heart Association, here is what you should do: