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When to refer to Hospice: Heart Failure

Patients with end-stage congestive heart failure (HF) often struggle with shortness of breath, fatigue, and frequent ER and hospital visits as their condition worsens. Our interdisciplinary hospice team can support patients with HF and their families by providing:

  • Expert clinical interventions to decrease shortness of breath, minimize fatigue, and lessen symptoms of anxiety.
  • Intensive education and proactive management of early signs and symptoms of fluid overload.
  • Proven strategies in decreasing ER visits, hospitalizations and enabling patients to remain in their own homes or facilities through the end of life.

In a study “Comparing Hospice and Non-hospice Patient Survival among Patients that Die within a Three Month Window” (Journal of Pain and Symptom Management, March 2007), congestive heart failure patients lived an average of 81 days longer when they had hospice care as compared to those that did not have hospice care.”

Here is the criterion that may indicate a patient is appropriate for hospice referral:

  • Diagnosis of heart disease (HF, chronic ischemic heart disease, left heart failure, old myocardial infarction).
  • Has had poor response to diuretics and vasodilators, has had a medical contraindication to those drugs, or has made a conscious decision not to take them.
  • Not a candidate for or has declined revascularization procedures.
  • Has an ejection fraction less than 20%.
  • Is unable to carry on any physical activity without dyspnea or chest pain.

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