Life-Limiting Heart Disease and Hospice Care – Part 1

Russ Krengel Diseases, Hospice

Hospice and palliative care for advanced cardiac disease provides many benefits for loved ones facing the end of life. Many of those needing hospice or palliative care have some form of heart disease. However, hospital admissions remain high among this group. Hospice care can reduce distress and improve the end of life for those with heart failure. Lastly, a study has shown that the mean survival period for patients with heart failure was 29 days longer for hospice patients.

The Benefits of Hospice Care for Patients with Heart Disease

Hospice care is typically reserved for those with a life expectancy of 6 months or less. It is provided for patients with life-limiting illnesses and combines pain management, emotional and spiritual support, in addition to medical care. Hospice care is typically provided where the patient resides, either in their home or care facility. Patients generally experience lower rates of hospitalization, admission to ICUs, and invasive medical procedures. Also, hospice care improves symptom distress, caregiver outcomes, and family and patient satisfaction.

Barriers to Use for Those with Heart Failure

Nearly 33% of Americans with heart failure who receive hospice are enrolled late. The short duration of hospice care can result in a poorer care experience for the patient and family members. There are many factors that can be a barrier to hospice use for those with heart failure, such as:

  • Disease Factors
  • Policy Factors
  • Clinical Factors
  • Other Factors

In this multi-part series, we will look at each one of the factors. Each has a distinct impact on the timeliness of patients to be referred to hospice care.

Disease Factors

Patients with heart failure may not receive timely referrals for hospice care due to the unpredictable nature of the disease. Providing an accurate prognosis is difficult. Patients can experience a gradual decline with intermittent exacerbations, that upon treatment, may return the patient to a near-normal pre-incident state. It is difficult to predict which incident will result in a life limiting prognosis. Lastly, a single incident may trigger a need for an immediate hospice referral.

The symptoms of heart failure can be severe. Dyspnea, pain, and fatigue are problematic and may require more intensive, or full-time care services. As patients decline, the symptom severity increases, resulting in patients being unable to perform daily activities. Many families are unable to provide support at home and are unable to afford care services. At-home care support can be underprepared and lack clinical knowledge on the condition and management. Thus, they are unprepared to deal with exacerbations when they occur.

Many patients with heart failure who may appear to be near death are candidates for invasive medical procedures. Hospice eligibility is unclear in these situations. Lastly, the nature of heart failure makes prognostication difficult. One study found less than 50% of physician were able to accurately estimate survival in patients with heart failure.

Hospice and palliative care are needed for patients with life-limiting heart failure. However, the issues still remain. The uncertainty of heart failure prognosis and its seemingly sporadic incidents will continue to make referring hospice and palliative care to patients difficult. However, medical professionals should consider hospice and palliative care to ease the at-home care burden and improve the quality of patient care.

In future articles, we will look at other factors which introduce barriers to hospice care referrals for patients with heart disease.