Heart Disease and Hospice
For practitioners, preventing recurrent patient hospitalizations for exacerbations is a daily challenge. And, most of the staggering cost associated with the care of these patients is attributable to hospitalizations. So, when is it time to consider end-of-life care?
The Heart Failure Society of America has developed extensive guidelines and recommendations for end-of-life care patients experiencing one or more of the following:
• Frequent hospitalization (3 or more
• Chronic poor quality of life with inability
to accomplish activities of daily living
• Need for intermittent or continuous
• Consideration of assist devices as
In an important article published in the Journal of Palliative Medicine, Dr. Brad Stuart suggested criteria for hospice eligibility as follows:
• Severity of illnesses (severe left
• Recent clinical progression (eg, 2 or
more hospital admissions, decline in
performing activities of daily living, and
other organ system dysfunction)
• Evaluation for advanced therapeutic
options (eg, implanted devices or
• Preference for comfort care over
Advance directives and end-of-life care.Heart failure has a shorter life expectancy than many common cancers; and the mortality rate is high, making advance directives and end-of-life care important issues for patients with this condition.
Discussion of end-of-life care is easier if the patient and family are aware early in the course of care. Some data suggest that patients prefer to be informed about issues related to their disease and its prognosis when they are relatively well. The inclusion of family members/caregivers is important because these patients often suffer from cognitive impairment, functional disabilities, and other conditions that limit their ability to fully comprehend.
In considering these issues, it is important to understand the distinction between advance directives and end-of-life care. Advance directives are legal documents created to identify desired or undesired treatments if an individual becomes incapacitated and incapable of making decisions about care. All patients should be encouraged to have this documentation in place.