Provider Tips for Prognostication in Heart Failure Patients - Heart 'n Home Hospice & Palliative Care, LLC
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Provider Tips for Prognostication in Heart Failure Patients

Although it has many benefits, hospice care is often underused by patients with heart failure, which is due to the difficult and unpredictable nature of heart failure. Hospice care often improves symptoms, quality of care, caregiver outcomes and patient and family satisfaction. 

Facts About Heart FailureHospice-Cardiac-Heart-medications

Sudden cardiac death is responsible for 50% of heart failure deaths. The New York Heart Association (NYHA) is better than the Ejection Fraction (EF) for prognostication. Mortality associated with NYHA*:
          • Class II: 5-10% mortality per year
          • Class III: 10-15%
          • Class IV: 30-40%

Other contributors to cardiac mortality**:
          • Cardiac hospitalization triples 1-year mortality; nearly 1:10 die within
            30 days.

          • Intolerance to neurohormonal therapy (beta blocker, ACE, ARB) is
            associated with high 4-month mortality.

          • Systolic BP <100 and/or pulse >100 doubles 1-year mortality.

          • Anemia (each 1g/dl reduction in Hg is associated with a 16% increase
            in mortality).

          • HypoNA, cachexia, low functional status, and co-morbidities. Use
            biomarkers if available: BNP, creatinine, troponin, or CRP.

Hospice Underutilized in Heart Failure Patients
Researchers have found that hospice and palliative care is associated with longer survival in some heart failure patients. Unfortunately, only one-third of American patients with heart failure receive hospice care at the time of death and those who do tend to enroll late in the course of their disease.***

Cardiac Hospitalization Mortality
In one study of hospitalized patients with heart failure, shockingly, the patients only had a median survival of 11 days and sadly, nearly one-quarter of patients died within 3 days.***

Short Length of Stay in Hospice = Fewer Benefits
The short length of stay in hospices is especially concerning, as this suggests that patients and their families may not receive the full benefit of the care.***

Late Referral Linked to Patient/Family Experience
The short length of stay in hospices is especially concerning, as this suggests that patients and their families may not receive the full benefit of the care.***

Americans Want to Die in Their Homes
The short length of stay in hospices is especially concerning, as this suggests that patients and their families may not receive the full benefit of the care.***

Benefits-of-hospice-cardiac-failure-heart-disease

Dr-Billy-Galligar-Hopsice-Heart-Education
Contributing Author: Dr. Billy Galligar, MD

*Bakitas M, MacMartin M, Trezepkowski K, et al. Palliative care consultations for heart
failure patients: how many, when, and why. J Cardiac Fail. 2015;8:193-201.

**Reisfield G MD, Wilson G MD, et al. #143 Prognostication in Heart Failure. Fast Facts, 2015.

***Cross, Sarah H et al. “Hospice Use Among Patients with Heart Failure.” Cardiac failure review vol. 5,2 93-98. 24 May. 2019, doi:10.15420/cfr.2019.2.2

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