By Ileana Leyva, MD, FAAHPM
Heart failure is often described as a chronic, manageable condition. For many years of the disease course, this statement may be true. But in advanced stages, this misconception can unintentionally delay essential comfort-focused care, prolong hospitalizations and place heavy burdens on patients and families.
From a clinical standpoint, end-stage heart failure tends to follow an unpredictable trajectory marked by recurring cycles of decline and temporary recovery, making timely referral to hospice far more complex than with other illnesses.
Despite heart disease remaining the leading cause of death in the United States, heart failure is still significantly underrepresented in hospice care, with studies suggesting that only about one in 10 patients with advanced heart failure are ever referred. The result is that many patients gain access to hospice only in their final days, missing opportunities for the full scope of comfort, stabilization, and support that hospice can provide.
Why Prognostication Is So Difficult in Advanced Heart Failure
Heart failure behaves differently from other terminal illnesses. Unlike diseases with clearly defined stages, such as cancer, or predictable levels of decline, such as Alzheimer’s and other dementias, heart failure lacks a linear, measurable progression — making accurate prognostication far more challenging for clinicians.
Patients often experience rapid fluid shifts, sudden dyspnea, angina and recurring inpatient stays. Many cycle through a pattern of crisis, treatment and partial rebound that masks disease severity. The “treatable until the end” myth is reinforced by these temporary improvements, even as the overall trajectory continues downward.
Optimal treatment may already have been provided, and patients may no longer be candidates for advanced medical or surgical interventions. When symptoms (fatigue, dyspnea at rest, weakness or recurrent chest pain) persist despite maximal therapy, this often signals a transition into the terminal stage.
Yet cardiologists and hospital teams may hesitate to initiate hospice conversations because heart failure’s unpredictable pattern makes timing difficult. This is where hospice, and especially a cardiac-informed hospice model, can make the greatest difference.
How Hospice Supports Patients With Advanced Cardiac Disease
Hospice does not require abandoning cardiac therapies. In fact, continued medications such as ACE inhibitors, beta-blockers, vasodilators and diuretics can remain integral to comfort-focused cardiac end-of-life care. Many patients and families are relieved to learn that hospice does not mean discontinuing symptom-improving treatments.
VITAS Healthcare also provides complex cardiac-focused modalities that support symptom stability, including:
- High-flow oxygen therapy
- IV/subcutaneous diuretics
- Oversight and support for patients with ICDs and VADs
These services are delivered wherever the patient calls home — private residences, assisted living communities, nursing facilities or inpatient hospice centers.
The VITAS model of care includes 24/7 clinical support, interdisciplinary visits and tailored emotional and psychosocial support for both patients and caregivers.
Setting a National Standard for Cardiac Hospice Care
VITAS has earned the American Heart Association (AHA) Palliative/Hospice Heart Failure certification across all 15 states in which it operates. VITAS extends AHA-certified, guideline-directed therapy across the care continuum, addressing the clinical, emotional and psychosocial needs of patients with advanced cardiac disease and their families. This certification affirms that VITAS follows evidence-based, guideline-directed cardiac care standards throughout the entire hospice journey.
For hospital teams, cardiologists and inpatient clinicians, this certification offers confidence that hospice care can seamlessly support goals of comfort while continuing therapies that enhance quality of life.
A Clinical Snapshot: When Earlier Hospice Makes the Difference
Take, for example, a composite case drawn from common scenarios across VITAS service areas:
A 79-year-old patient with NYHA Class IV heart failure experiences weekly dyspnea episodes and multiple emergency department visits for fluid overload. Despite maximal therapy, she becomes increasingly fatigued, sleeping upright to breathe comfortably. After one more hospitalization, her care team discusses hospice.
Under VITAS, she receives home-based IV diuretics, high-flow oxygen and interdisciplinary support. The frequency of acute episodes decreases, and she remains at home — comfortably, safely and surrounded by family.
This is what timely hospice involvement can provide.
A Call to Action for Healthcare Professionals
Hospice is not the end of treatment; it is the continuation of expert care when cure is no longer the goal. With advanced cardiac disease, earlier involvement opens the door to symptom relief, fewer hospitalizations, enhanced emotional support and dignity throughout the final stage of life.
Refer hospice-eligible patients to the compassionate care they deserve: Download the VITAS Healthcare mobile app, visit VITAS.com/Refer or call 800.93.VITAS.
Dr. Ileana Leyva is a regional medical director for VITAS Healthcare. Learn more about end-of-life care at VITAS.com.
