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Learning Objective 1: Describe when hospice is appropriate for end-stage heart failure patients.
Learning Objective 2: Evaluate the outcomes related to a cohort of heart failure patients referred to a specially trained hospice.
Hospice is an underutilized option for advanced heart failure (HF) patients at end of life (EOL). Barriers include difficulty predicting EOL in this population and limited expertise of hospice staff in the management of heart failure. Lack of knowledge about HF pathophysiology, clinical assessment and evidence based therapies may lead to a lack of providing treatments as a means of palliation. The purpose is to determine if referral to a HF trained hospice for EOL management reduces healthcare cost while maintaining patient and family/caregiver satisfaction.
Methods:
A retrospective review of 12 patients referred for hospice care after palliative management in the outpatient HF clinic (HFC) of a large private, non-profit, managed care hospital. The hospice was provided HF-specific education. IV inotropes (n=4) and IV diuretics (n=8) where used in accordance with the ACC/AHA Guidelines for EOL HF management. HFC cardiologists and nurses remained in contact with the hospice staff.
Results:
The N= 12 (10 men, 2 women), (age 67.7 ( 14.1), (systolic 8, diastolic 4). Time in HFC before referral to hospice was 1 day to 7.5 years. Hospitalizations before and after referral to the HFC for this HF EOL cohort increased from 3.0 ( 3.1) to 6.3 ( 7.3) over an average of 29.2 months. Total hospital days one year prior to hospice referral were 293 (range 5-92). Total hospice days prior to death were 577 (range 5-270). Hospice care (9.8% inpatient, 94.1% home, 0.5% home continuous care) cost 79% ($365,000) less. Patients and families expressed gratitude and relief with hospice services.
Conclusion:
Healthcare cost for hospice was low and patient and family satisfaction was high. Research is needed to identify best predictors for timing of hospice referral. Hospice staff education is essential for patient, family, and cardiologist confidence in transitioning the HF palliative care patient to hospice.
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