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Cardiology

Hospice, Palliative Medicine Should Be First-Line Care Options

for Advanced Cardiac Disease

Recent studies of patients emergency department and patient’s medical management has been ized and might die there?
with advanced heart dis- outpatient clinic decreased maximized and no surgical options • Or aggressive, comfort-focused car-
ease or heart failure uncov- near the end of life - even remain, what are their care options? diac care from a hospice team that comes
er two important healthcare though 82% were hospital- What’s important for South Florida’s to them over weeks and months?
trends: ized at least once in their healthcare providers to understand is that If severely ill cardiac patients are
• First, progress is being last year and 28.4% died in many of the medical interventions current- offered comfort-focused palliative care
made in referring patients the hospital. ly provided in hospitals can now be deliv- and hospice care early in their process of
early in their disease In a 2017 study by the ered in outpatient settings and at home on functional decline, they can avoid exces-
process to hospice and pal- Icahn School of Medicine at hospice care; both options offer a benefit sive interventions and recurring hospital-
liative care to manage their Mount Sinai, the median to patients and healthcare providers alike. izations, and worry less about their next
symptoms and support length of stay on hospice Hospice offers an alternative treatment cardiac event. Healthcare providers, like-
quality of life near the end for heart failure patients option at a point when their disease and wise, can benefit from fewer rehospital-
of life. was a short 15 days, with symptom management are virtually one izations, and lower costs and reduced
• Second, opportunities BY DR. PAUL 40% dying within a week of and the same therapy. burdens of unnecessary care.
remain to ensure that all PUGLIESE hospice enrollment. The Ideally, the next evolution of care for
eligible cardiac patients are U.S. Department of Health Which option provides patients with advanced cardiac disease
offered hospice and palliative care as and Human Services recommends at least the most benefit? will introduce palliative care earlier in
legitimate treatment options in more 30 days of hospice care for patients to Some of our hospice teams in South the disease process and in more settings,
healthcare settings and early enough to receive the full benefit of its focus on Florida, for example, now offer complex including outpatient clinics, specialty
take full advantage of aggressive, com- comfort and quality of life. modalities at home - including inotropes, clinics, community health settings, nurs-
fort-focused interventions that can now IV diuretics, respiratory therapy, pallia- ing homes, assisted living communities
be offered at home - the setting where the Who are your patients with tive-focused medications, LVAD support and the like. Doing so supports patient-
majority of them prefer to be near the advanced heart disease? and other interventions - to manage the centered care focused on improved qual-
end of life. Those of us who care for patients with high-acuity symptoms associated with ity of life and reduced symptom burden,
For example, a 2015 Mayo Clinic advanced cardiac disease know that their heart disease and related comorbidities. allowing patients to stay at home or in
study found that the rate of hospice use health usually deteriorates over months Given the choice, heart disease their preferred setting of care.
among patients with heart failure and years. They typically spend a great patients should be evaluated for future
increased from 28.6% to 42.2% over a 10- deal of time in healthcare clinics and hos- care based on a simple question: Which Dr. Paul Pugliese is medical director for
year period (2003-2012), while palliative pitals, worrying about when their next cardiac care option will provide the most VITAS® Healthcare in Miami-Dade and
care consultations increased from 10.8% cardiac event will happen. Will they end benefit? Monroe counties. For more information about
to 43.6%. As hospice and palliative care up back in the hospital, and if so, is that • More medications and surgeries, hospice and end-of-life care,
increased, their trips to the hospital, where they really want to be? If the knowing that many will be re-hospital- call (866) 759-6695 or visit VITAS.com.

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South Florida Hospital News southfloridahospitalnews.com February 2020 23