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Even before COVID-19 dramatically changed the healthcare landscape in early 2020, hospice care was proven to achieve results that hospitals and healthcare systems desire: lower in-hospital mortality, fewer patients spending their last days in a hospital room or intensive care unit, and improved quality of life for hospice-eligible patients and their families.
Hospice’s value to our healthcare colleagues is even more profound in 2021, especially as many hospitals and their hard-working, dedicated staff members continue to struggle under the overwhelming hospitalizations of COVID-19 patients who require inordinately high levels of intensive care and staffing.
As the nation marks February as American Heart Month, studies continue to encourage early, timely referrals of patients with advanced cardiac disease to hospice care because of dual benefits:
• Improved care and enhanced quality of life for patients
• Higher levels of satisfaction with care for their family members and caregivers
Added to those benefits in 2021 are the hospice team’s ability to provide care safely at home, allowing patients and their families to spend cherished time together while sparing patients the risks and burdens of hospitalization during a pandemic. Interdisciplinary teams can deliver to the home an array of services—in person and virtually—including complex modalities for patients whose advanced heart disease requires high-acuity care.
Hospice Care at Home for Advanced Heart Disease Is an Option During COVID-19
A 2017 study in Circulation: Heart Failure (Gelfman, et. al) retrospectively analyzed healthcare use among Medicare beneficiaries with advanced heart failure who used home healthcare in 2009. Patients were included in the study if they experienced two heart failure-related hospitalizations within a six-month period and then enrolled in hospice. Among the 5,073 patients who enrolled in hospice:
• Mean time from hospital discharge to hospice enrollment was 45 days.
• Mean time from hospice enrollment to death was 71 days.
• About half died within 16 days of hospice; 39% died within seven days.
In the first six months of hospice enrollment, compared with the six months prior to hospice:
• Mean hospital admissions per patient decreased from 2.56 to 0.53.
• Mean ICU admissions decreased from 0.87 to 0.19.
• Mean ER visits decreased from 1.17 to 0.76.
Of the 568 patients (11%) who died without hospice care, nearly half died in an acute hospital facility, and 17.6% died in a skilled nursing facility or rehabilitation center, even though national opinion surveys indicate that nearly 80% of Americans say they would prefer to die at home.
Based on these and other findings, the study’s authors stress the importance of earlier hospice referrals for patients with advanced heart failure, noting that the “unpredictable trajectory of heart failure makes prognostication challenging.” Earlier and longer enrollment in hospice, they point out, can enable patients to experience the full benefits of the medical, emotional, and spiritual support provided by the hospice team.
The benefits increase because of hospice’s agile response to COVID-19. Hospice teams have embraced and deployed telehealth and enhanced care protocols that support safe and compassionate patient evaluations, admissions to hospice, in-home care, caregiver education, psychosocial support and ongoing virtual/phone bereavement services.
Know When to Refer Patients With Heart Disease to Hospice
Primary care physicians and cardiologists can look for key symptoms and signs of decline that indicate hospice eligibility. Medicare guidelines require a prognosis of six months or less if the disease runs its natural course, and physicians can leverage clinical judgment and additional information as they explore care options and preferences with their patients.
Typically, patients with cardiac disease are eligible for hospice care if they meet New York Heart Association (NYHA) Class III status with fatigue, palpitations, or 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.
