Hospice for Heart Disease and Heart Failure

Heart disease refers to a range of conditions that affect the heart, including coronary artery disease, congestive heart failure and heart valve disease. It’s one of the leading causes of death worldwide with risk factors that include high blood pressure, high cholesterol, smoking, obesity, diabetes and family history. Symptoms of heart disease can vary depending on the type and severity of the condition, but may include chest pain, shortness of breath, fatigue, dizziness and palpitations. Treatment options may include lifestyle changes, medications, procedures, such as angioplasty or bypass surgery, or devices such as pacemakers or defibrillators. Prevention through healthy habits such as regular exercise, a healthy diet and not smoking is important in reducing the risk of heart disease.

Congestive Heart Failure (CHF)

Congestive Heart Failure (CHF) is a type of heart disease in which the heart’s ability to pump blood is reduced, leading to a build-up of fluid in the body. This can cause symptoms such as shortness of breath, fatigue, swelling of the ankles, feet or legs and difficulty exercising. CHF can be caused by a variety of factors, including coronary artery disease, high blood pressure, heart valve disease and certain types of heart infections. Treatment for CHF may include medications to improve heart function and reduce fluid buildup, lifestyle changes such as a low-sodium diet and exercise, and sometimes medical procedures such as implantation of a pacemaker or defibrillator, or heart transplant surgery. It’s important to manage CHF effectively to avoid complications and improve quality of life.

Four Stages of CHF

Congestive heart failure (CHF) is a type of heart disease that can progress through four stages, with symptoms worsening as the disease progresses.

• Stage A: a patient may be at risk for developing CHF but does not yet have any symptoms. Risk factors for CHF include high blood pressure, diabetes, obesity and a history of heart disease.
• Stage B: a patient has developed structural heart disease, such as a weakened heart muscle or damaged heart valves but does not yet have symptoms of heart failure. This stage is also known as asymptomatic or pre-heart failure.
• Stage C: a patient has developed symptoms of heart failure, such as shortness of breath, fatigue and swelling in the legs or ankles. Treatment at this stage may include medications to manage symptoms, lifestyle changes and procedures such as angioplasty or bypass surgery.
• Stage D: a patient has advanced heart failure that is no longer responding to treatment. Symptoms may be severe and include shortness of breath at rest, chest pain and difficulty sleeping. Hospice care may be appropriate at this stage to manage symptoms and provide comfort and support to the patient and their family.

Other Types of Heart Disease

There are several other types of heart disease and complications:

• Coronary Artery Disease (CAD): This is the most common type of heart disease caused by a buildup of plaque in the arteries that supply blood to the heart muscle. It can cause chest pain (angina) and increase the risk of heart attack.
• Arrhythmias: These are abnormal heart rhythms which can cause the heart to beat too fast, too slow, or irregularly. They can be caused by a variety of factors, including heart disease, electrolyte imbalances and certain medications.
• Heart Valve Disease: This occurs when the valves that control blood flow through the heart become damaged or diseased, leading to symptoms such as shortness of breath, fatigue and swelling of the ankles, feet or legs.
• Cardiomyopathy: This is a disease of the heart muscle itself which can cause the heart to become enlarged, thickened or stiff. It can lead to symptoms such as shortness of breath, fatigue and heart failure.
• Aortic Aneurysm: This is a bulging or ballooning of the aorta, the main artery that carries blood from the heart to the rest of the body. If left untreated, it can rupture and cause life-threatening bleeding.
• Peripheral Artery Disease (PAD): This is a condition in which the arteries that supply blood to the limbs become narrowed or blocked, leading to symptoms such as leg pain, cramping, and weakness.

Signs That It May Be Time for Hospice

Signs that it may be time for hospice care for heart disease or CHF can include recurrent hospitalizations, increasing difficulty breathing, and declining overall health status.

Life Expectancy and Hospice Eligibility

Determining life expectancy in heart disease can be a complex process and only a doctor can make such determinations. This is because many factors can affect a patient’s prognosis, including the type and severity of the heart disease, the patient’s overall health status and the effectiveness of medical treatments. Doctors use a variety of tools and assessments to estimate a patient’s life expectancy, including physical exams, medical tests and risk prediction models. In addition, life expectancy is just one aspect of care for patients with heart disease. Other factors such as quality of life, symptom management and emotional support should also be considered.

Some of the common criteria used by physicians to determine hospice eligibility include:

• Stage D heart failure: This is the most advanced stage of heart failure, in which symptoms are severe and medical treatments are no longer effective at prolonging life or managing symptoms.
• Frequent hospitalizations: Patients with heart disease or CHF who require frequent hospitalizations may be eligible for hospice care.
• Declining functional status: Patients who experience a decline in their ability to perform activities of daily living may be eligible for hospice care.
• Uncontrolled symptoms: Patients with heart disease or CHF who experience uncontrolled symptoms such as severe shortness of breath, chest pain, or fatigue may be eligible for hospice care.
• Prognosis of six months or less: Patients who are estimated to have a life expectancy of six months or less, based on a physician’s assessment, may be eligible for hospice care.

Benefits of Utilizing Hospice Care for Heart Patients and Their Loved Ones

Hospice care can benefit patients with heart disease or CHF by managing symptoms, providing emotional support and improving overall quality of life. Other benefits for hospice patients and their loved ones include:

• Improved symptom management: Hospice care focuses on managing a patient’s symptoms and maintaining their comfort, which can help prevent or reduce hospital admissions. Hospice providers work closely with patients and their families to develop personalized care plans that address their unique needs and preferences for managing symptoms, such as pain, shortness of breath and edema.
• Care coordination: Hospice providers work closely with a patient’s primary care physician and other medical professionals involved in their care to ensure that all aspects of their care are coordinated and aligned with the patient’s wishes and goals. This can help prevent medical errors, avoid unnecessary interventions and ensure that patients receive the right level of care at the right time.
• Education and support: Hospice care providers offer education and support to patients, families and caregivers on how to manage their symptoms and address their care needs at home. This can help reduce the need for hospitalization and improve patients’ quality of life. Hospice staff can also provide emotional and spiritual support to help patients and families cope with the challenges of heart disease and end-of-life care.
• Advanced care planning: Hospice care can help patients and families make informed decisions about their care and plan for the future. This can include discussions about advance directives, end-of-life care preferences and palliative care options, which can help prevent unwanted hospitalizations and ensure that patients receive care that aligns with their wishes.

How Hospice Can Help Patients with Heart Disease and Heart Failure

The goal of hospice care is to provide patients with expert care during their end-of-life journey. All hospice services can be provided wherever you call home and are in accordance with your values and preferences for your care. The hospice team and medical director review the plan of care every 15 days, or more often if necessary. Your primary physician will authorize any changes to the plan of care as appropriate throughout the hospice journey. Here’s how hospice care can be beneficial:

Education

The care team educates patients and families about the disease process, what to expect, how to manage symptoms and reduce anxiety and uncertainty.

Proactive Symptom Management

Proactive symptom management and timely interventions can reduce unnecessary hospitalizations.

Emotional Support

Hospice care supports both patients and families, helping them cope with the challenges and emotions associated with a terminal diagnosis.

Personal Care

Hospice aides can assist with daily activities like bathing, dressing and mobility, to manage personal hygiene and support with dignity.