While heart disease is the number one cause of death among adults in the United States, only 6.4% of Medicare hospice beneficiaries have a primary diagnosis that is heart-related. That means many patients with congestive heart failure or other cardiac conditions are dying alone or in the hospital without comfort care and loved ones by their side.
Heart to Heart Hospice works to decrease access barriers to hospice with a specialized program, Care Bridge Cardiac Care, for patients suffering from end-of-life heart disease. Treating symptoms at home or in a residential facility by providing comfort care helps mitigate unnecessary emergency room visits or hospitalizations.
“Hospice care greatly impacts those with cardiac disease,” said Rosalba Marquez, Patient Care Manager with Heart to Heart Hospice in Permian Basin/Midland, Texas. Often, cardiac patients are put on hospice with unrelieved chest pain, shortness of breath, and dizziness, among other symptoms. Nurses work to stay ahead of the symptoms to ensure comfort. “Placing these patients under the Care Bridge Cardiac program ensures we focus on heart disease and quickly get medications to manage their symptoms. Patients and families are grateful to see some relief. We can then focus on emotional support for patients and families.”
Overcoming Barriers to Cardiac Hospice Care
Hospice care for cardiac patients is under-utilized, with many contributing factors. Once a doctor has determined a patient has a life expectancy of six months or less and curative treatments are no longer desired or working, they can refer patients to hospice. According to the NHPCO 2021 report, the average days on hospice services for cardiac patients was 85.4 days, while Medicare hospice benefits cover patient care for six months (sometimes longer, depending on the patient’s prognosis). As referenced in this study: “In one study of hospitalised patients with HF [heart failure], those discharged to hospice care had a median survival of 11 days and nearly one-quarter of patients died within 3 days.”
- Several barriers exist to accessing hospice care for heart failure, including the disease itself, policy requirements, clinical factors, and more. (Source: Infographic by Radcliff.) Some major hurdles include:
- An unpredictable trajectory of disease.
- Symptom burdens and the frequent need for invasive palliative (comfort) interventions, such as IV medicines.
- Difficult prognostication by clinicians and timely referrals.
- Patients and families overestimating survival and waiting too long to start hospice.
- Lack of partnership and integration between cardiac physicians and hospice partners.
- Policy obstacles including six-month prognosis and low fixed daily payment rates.
- Hospice staff discomfort or lack of training in heart failure.
Heart to Heart Hospice, a leading hospice provider in Texas, Michigan, and Indiana, works to address many of these top concerns, including hospital partnerships and extensive staff training for cardiac care.
- This study published by the Cardiac Failure Review recommends several ways to address the gap of cardiac hospice care, including:
- Further hospice education for cardiologists.
- Earlier palliative care measures and hospice enrollment for heart patients.
- Increased flexibility for hospice eligibility.
- New care and payment models for heart-related hospice.
- Increased research and hospice staff education.
- Overcoming social barriers to reduce hospitalizations and increase in-home care.
Benefits of Care Bridge Cardiac Care
Chest pain, shortness of breath, swelling, and other symptoms of advanced cardiac disease can be scary and overwhelming. Heart to Heart Hospice’s specialty program Care Bridge Cardiac Care is designed to meet the unique end-of-life needs for heart patients at home or a residential facility. Educating patients and their caregivers to “stay ahead” of symptoms helps reduce emergency room visits and hospital admissions.
“Research has been found that both hospice and palliative care are associated with longer survival in patients with heart failure related diagnosis,” said Jennifer Ellett, with Heart to Heart Hospice in Ft Worth. “Hospice care helps to ameliorate distress at the end of life for patients with heart failure; exacerbations are reduced by simply initiating comfort care sooner.”
In addition to medications and pain management, cardiac patients also receive needed medical equipment like adjustable beds, oxygen, and disposable supplies for wound care or other physical needs.
Heart to Heart Hospice also employs compassionate, skilled team members to address the unique emotional, spiritual, and relational needs of patients, which includes social workers, spiritual care coordinators, and hospice aides. Plus, a nurse is only a phone call away 24/7, in between scheduled visits for assessment and medical adjustments.
Additionally, hospice employees and volunteers offer companionship and guidance to ensure the final weeks are filled with quality interactions (including capturing memories and last wishes), and assistance on planning for the future. Short-term respite services are also available to provide a break for caregivers. Finally, hospice support extends beyond the death of the patient, including 13 months of bereavement care.
“Hospice Care for cardiac patients encompasses education and interventions to help manage common symptoms such as shortness of breath, chest pain, weakness/fatigue, and functional decline that are often related to cardiac disease. The security of having an entire team with physicians, 24-hour nurse availability, aide services, a chaplain, and social worker to help throughout the journey in their home setting is comforting,” said Staci Griffith, a Patient Care Manager for Heart to Heart Hospice in East Texas. “Patients often report, ‘I wish I had started hospice earlier, I would have saved myself many hospital visits.’”