Many factors probably contribute to the increased longevity. Hospice care increases monitoring in the home and gives psychological, emotional and spiritual support from friendly visitors. This holistic attention may increase the desire to live and reduce the sense of being a burden to one’s family.
Skipping the ER
Heart failure is the diagnosis most commonly associated with hospitalization. By some estimates, patients with heart failure are readmitted at a rate of nearly 50% within six months. For some patients, knowing that they have 24-hour access to nursing advice and visits for management of symptoms gives them a welcome alternative to the emergency room.
Who is Appropriate?
Medicare guidelines include:
- Patient is optimally treated with vasodilators or unable to tolerate them.
- Patients with conditions usually treated with surgery are either ineligible or decline it.
- Patient is Class IV on the New York Heart Association scale: unable to do any physical activity without discomfort and symptoms may be present at rest.
- If ejection fraction is available, 20% or less is appropriate for hospice.
- Co-morbidities play a large role in estimating prognosis. The following co-morbidities support a prognosis of 6 months or less in conjunction with the conditions listed above:
- Symptomatic arrhythmias resistant to treatment
- History of cardiac arrest, resuscitation or unexplained syncope
- Brain embolism of cardiac origin
- Concomitant HIV disease
- Do you have discomfort when physically active? or Does physical activity give you more discomfort?
- Do you get short of breath when you are lying down?
- Do you ever wake up at night feeling short of breath?
- When you are resting in a chair do you ever feel short of breath, perspire or have chest pain?
- Do you have any swelling?
- Do you need help with activities like dressing, bathing, walking or eating?
- Dusky nail beds
- Tachycardia or bradycardia
- Hyper- or hypotension
- Jugular venous distension
- Liver enlargement
- Paroxysmal nocturnal dyspnea
- Decreased ejection fraction
- Weight gain due to fluid retention
This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 24. To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.