Palliative Care and Hospice for People with Heart Failure

Traditional medical care for heart failure (HF) is aimed at improving heart function and/or delaying progression with medications, and managing symptoms. People with HF are at risk for sudden clinical decline or cardiac death. Good communication is important to identify an individual’s goals of care including end-of-life issues.¹ Palliative and hospice care are both options that should be considered as patients near the end of life. Guiding patient and family expectations, helping them find appropriate strategies to cope with the eventuality of death, and providing relief of HF symptoms are all part of the considerations of selecting palliative and hospice care.²

Palliative and hospice care can both improve quality of life using a holistic approach to symptom and pain management.¹ The two are related in their objectives to prevent and relieve suffering and to support the best possible quality of life.

Palliative care

Palliative care is a multidisciplinary approach to medical care designed to improve quality of life and provide symptom management, as well as understanding choices for medical treatment.³ Unlike hospice care, it does not depend on prognosis. It is offered alongside curative treatments, sometimes as early as the time of diagnosis.²

A palliative care team can include doctors, nurse practitioners, nurses, social workers, therapists and others who will support the social, emotional, and medical needs of the patient and their family.⁴ It is an integrative approach that offers a sense of control and the opportunity for an improved quality of life for both patients and their caregivers.²

Palliative care can be incorporated into a standard HF treatment plan as soon as someone becomes symptomatic. Implementation of palliative care does not have to wait until the end of life is near. It can serve to educate people about end-of-life care options so that they can begin a dialogue with their healthcare team and their families or caregivers in advance. Those who receive palliative care may be better prepared to talk about the kind of end-of-life decisions they desire.^3,5 Palliative care practitioners are typically additions to your standard medical care team. Medicare may cover palliative care. Check with your insurance carrier or Medicare for your eligible benefits.³

Hospice care

Hospice care focuses on quality of life remaining for people and their caregivers in the advanced stage of a terminal illness. Hospice care can be provided in the home, in a hospital or a freestanding facility.⁶ The objective is to provide compassionate care so that patients and their families are as comfortable and supported as possible in the last stages of life.^4,6

When someone transitions to hospice care, they are either no longer responding to medical treatment or have elected to stop further care that would prolong their life. It can feel like a difficult decision because it is a recognition that death, although not necessarily immediate, is soon. Yet most people find hospice services comforting.³ It is a specialty where providers of all kinds are trained in supporting the patient and family through death. Hospice is a specialty service that requires a medical referral and can be prescribed for people with advanced HF, frequent hospitalizations, or worsening functional status that is thought to have less than 6 months to live.^1,3,6

Medicare and private insurance generally cover hospice care during the last 6 months of life.⁶ It can be hard to predict the course of HF, and doctors may find it difficult to predict exactly how long someone will live. HF generally worsens over time and sometimes the decline is slow. You can start and stop hospice or get an extension if you outlive the estimated time.^3,5

Palliative and hospice care programs

Palliative and hospice programs can support the psychosocial
and emotional reactions to the whole range of the heart failure experience from diagnosis to bereavement.² There are numerous local and national resources that can help you get information to help you explore palliative and hospice care services.

National Hospice and Palliative Care Organization
www.caringinfo.org
800-658-8898 (toll-free)

Center to Advance Palliative Care
www.getpalliativecare.org
212-201-2670

Hospice Association of America
http://hospice.nahc.org
202-547-7424

Hospice Foundation of America
http://hospice.nahc.org
800-854-3402 (toll-free)

Education in Palliative and End-of-Life Care
www.epec.net
312-503-3732

Visiting Nurse Associations of America
www.vnaa.org
888-866-8773 (toll-free)

Family Caregiver Alliance
www.caregiver.org
800-445-8106 (toll-free)

Figure 1. Palliative care vs. hospice