Are Cardiologists Underusing Hospice?

With February being American Heart Month, the connection between heart disease and hospice carries a much greater sense of urgency.

All the better, some say. Several recent studies have begun to cast light on what many medical professionals – particularly those in the field of palliative care – view as a perplexing problem. That problem is the perception that cardiologists are more likely than other specialists to avoid recommending hospice and palliative care for their patients.

Why is it such a problem? 

According to a study published in the September 2017 issue of the Journal of the American College of Cardiology, patients with cardiovascular disease were much more likely to die in medical or nursing facilities than in hospice.

And while the number of patients in hospice dying from cardiovascular disease has increased, that number is well below that of the general U.S. population. In 2015, cardiovascular disease accounted for 32 percent of total U.S. deaths, but only 16 percent of hospice deaths, the study reports.

Underlying Reasons for Underutilization

According to Dr. Tim Ihrig, Chief Medical Officer for Crossroads Hospice & Palliative Care, such findings are not surprising.  Over the past 20 years, medical science has greatly expanded the ability to extend the lives of patients with heart disease.  As a result, many more patients with heart disease are able to survive events that previously would have been fatal.

But that success also comes with drawbacks – such as the unwillingness of doctors to accept that a patient’s death is inevitable, or that the patient’s quality of life may suffer as a result of the kinds of treatments that are necessary to keep them alive. 

“Cardiologists are trained to save people’s lives,” Ihrig says. “But what they have trouble coming to grips with is the reality that every human being is a physical organism. There is an inevitable turning point where the functional capacity declines because the body wears down. Inevitably, death is a fact of life.”

Palliative Care Pluses 

It’s during that phase of decline when palliative care can be most effective – by easing pain that the patient may experience and otherwise trying to enhance the patient’s quality of life, says Dr. Ihrig. And patients who have cancer or congestive heart failure can receive palliative care without needing to forego curative treatment.

In addition, palliative care has proven effective in reducing hospital readmissions. Dr. Ihrig notes that prior to joining Crossroads, an across-the-continuum palliative care program he conducted achieved a rate of 95 percent zero hospitalizations for congestive heart failure patients. 

The palliative care program elicited a patient satisfaction score of 95 according to a Press-Ganey survey – higher than any other specialty program in that system and above the national average. This compared to non-palliative congestive heart failure patients who had a 30-day readmission rate of over 20 percent. 

Therein lies a lesson that cardiologists need to hear, says Ihrig. The fact is, patients with heart disease represent the greatest population in need of palliative care, according to a report from the World Health Organization. In the U.S., the problem is further exacerbated by findings such as those in a recent JAMA study that patients with heart disease are less likely to receive palliative care consultations than patients with cancer.

Hope on the Horizon 

In July, 2017, the Journal of the American College of Cardiology, published the results of another study exploring the use of palliative care for heart failure patients in outpatient settings. An accompanying editorial lauded the study’s authors for providing new insights demonstrating that palliative care had significant benefits for patients in terms of quality of life, depression, anxiety, and spiritual well-being.  

“(The authors) have shown that PC delivers an aspect of care important to our patients and lacking from our medical armamentarium,” the editorial said. “Considering the effect of the interventions applied… it highlights that all practitioners should incorporate PC practices into their care” of patients with heart disease. 

The need to educate cardiologists about palliative care will be another important requisite moving forward, the editorial says.

Incorporating Patient Perspectives

The final key should be the inclusion of the patient perspective, says Dr. Ihrig.  

“Palliative care is meant to be an empowering force for patients,” he says. “It’s meant to take into account how the patient as an individual feels about what it means to be living with a severe chronic, potentially fatal disease such as cardiovascular disease.” 

“It’s not just acquiring as many candles on the birthday cake as possible. It’s about helping people live their lives to the highest quality possible and be the boss of that,” Dr. Ihrig says. “Somewhere along the way we may have lost that perspective, and it’s time we get back to it.”

To learn more about how palliative care can help support patients with heart disease, visit the Crossroads website of give us a call at 1-888-564-3405.

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