Page 20 - SFHN Feb 2021

Cardiology

Hospice Care at Home for Heart Disease:

A Timely Solution for Hospitals, Patients, and Families

Even before COVID-19 dramatically changed the healthcare landscape In the first six months of hospice enrollment, compared with the six
in early 2020, hospice care was proven to achieve results that hospitals and months prior to hospice:
healthcare systems desire: lower in-hospital mortality, fewer patients • Mean hospital admissions per patient decreased from 2.56 to 0.53.
spending their last days in a hospital room or intensive care unit, and • Mean ICU admissions decreased from 0.87 to 0.19.
improved quality of life for hospice-eligible patients and their families. • Mean ER visits decreased from 1.17 to 0.76.
Hospice's value to our healthcare colleagues is even more profound in Of the 568 patients (11%) who died without hospice care, nearly
2021, especially as many hospitals and their hard-working, dedicated staff half died in an acute hospital facility, and 17.6% died in a skilled nurs-
members continue to struggle under the overwhelming hospitalizations of ing facility or rehabilitation center, even though national opinion sur-
COVID-19 patients who require inordinately high levels of intensive care veys indicate that nearly 80% of Americans say they would prefer to
and staffing. die at home.
As the nation marks February as American Heart Month, studies contin- Based on these and other findings, the study’s authors stress the
ue to encourage early, timely referrals of patients with advanced cardiac importance of earlier hospice referrals for patients with advanced
disease to hospice care because of dual benefits: BY DR. ILEANA LEYVA heart failure, noting that the “unpredictable trajectory of heart failure
• Improved care and enhanced quality of life for patients makes prognostication challenging.” Earlier and longer enrollment in
• Higher levels of satisfaction with care for their family members and hospice, they point out, can enable patients to experience the full ben-
caregivers efits of the medical, emotional, and spiritual support provided by the
Added to those benefits in 2021 are the hospice team’s ability to provide care safely hospice team.
at home, allowing patients and their families to spend cherished time together while The benefits increase because of hospice’s agile response to COVID-19. Hospice
sparing patients the risks and burdens of hospitalization during a pandemic. teams have embraced and deployed telehealth and enhanced care protocols that sup-
Interdisciplinary teams can deliver to the home an array of services—in person and port safe and compassionate patient evaluations, admissions to hospice, in-home care,
virtually—including complex modalities for patients whose advanced heart disease caregiver education, psychosocial support and ongoing virtual/phone bereavement
requires high-acuity care. services.

Hospice Care at Home for Advanced Heart Disease Know When to Refer Patients
Is an Option During COVID-19 With Heart Disease to Hospice
A 2017 study in Circulation: Heart Failure (Gelfman, et. al) retrospectively ana- Primary care physicians and cardiologists can look for key symptoms and signs of
lyzed healthcare use among Medicare beneficiaries with advanced heart failure who decline that indicate hospice eligibility. Medicare guidelines require a prognosis of six
used home healthcare in 2009. Patients were included in the study if they experienced months or less if the disease runs its natural course, and physicians can leverage clin-
two heart failure-related hospitalizations within a six-month period and then enrolled ical judgment and additional information as they explore care options and preferences
in hospice. Among the 5,073 patients who enrolled in hospice: with their patients.
• Mean time from hospital discharge to hospice enrollment was 45 days. Typically, patients with cardiac disease are eligible for hospice care if they meet New
• Mean time from hospice enrollment to death was 71 days. York Heart Association (NYHA) Class III status with fatigue, palpitations, or
• About half died within 16 days of hospice; 39% died within seven days. angina/shortness of breath during less-than-normal activity or exercise. Often, these
patients are comfortable only when they are at rest. Hospice should also be considered
in patients who have other underlying disease or risk factors, or who are being treated
optimally with no improvement or no available surgical options.
During the COVID-19 pandemic, no patient should fear going to the hospital for
underlying heart disease. Hospice is a safe, patient-centered solution that provides
compassionate care in the patients’ homes, where they prefer to be.

t &
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W World-CClass He art Dr. Ileana Leyva is regional medical director for VITAS® Healthcare, the nation’s leading

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provider of end-of-life care. To refer a patient or for information, call 800-93-VITAS or
V V asscula r Servicesces download the VITAS mobile app at VITASapp.com for interactive
hospice eligibility guidelines.
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20 February 2021 southfloridahospitalnews.com South Florida Hospital News