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Helping End-of-Life Cardiac Patients Avoid the Hospital

Bronx resident Jermaine*, 81, suffered from heart failure. Because of his age, he was not eligible for a heart transplant, but his life had been extended significantly by a left ventricular assist device, or LVAD—a battery-operated mechanical pump surgically implanted in patients with late-stage heart failure.

Even with his LVAD, however, Jermaine had just a few months to live—so he enrolled in VNSNY Hospice and Palliative Care, where he was cared for by cardiac hospice nurse Diane K. Utilizing nursing skills she was taught through VNSNY’s new cardiac hospice program, Diane worked closely with Jermaine’s cardiologist, social worker, and other hospice team members to help him manage his LVAD and other issues related to his cardiac condition, which allowed him to live comfortably at home rather than be transferred to a skilled nursing facility.

When Diane agreed to take on the case, she received specialized LVAD training from cardiac nurse practitioner Fran Dooley, who coordinates the cardiac hospice program, and Jermaine’s attending physician at Mount Sinai. “I tend to volunteer for different experiences,” says Diane, who’s been a hospice nurse for almost two decades.

While she’s cared for a number of cardiac patients in the past, she adds, the interdisciplinary approach of VNSNY’s cardiac hospice program is unique. The program—the only one of its kind in New York City—was started in 2016 to address a critical problem: When a hospice patient is suffering from heart failure, they can often fall into a cycle of repeated hospitalizations because families rush their loved one to the emergency room because they’re struggling for breath. To avoid these unwanted trips to the hospital, this specialized program focuses on effectively managing a patient’s heart failure symptoms at home.

As with all cardiac hospice cases, Diane began educating Jermaine and his family about his condition during the first visit. “We talk about where the patient would like to be as things start to change—which is usually at home,” she says. “Many patients are afraid and don’t know what to expect. But when I tell them, ‘This is about you,’ they are pleasantly surprised.” She also drills the family on techniques to use if the patient starts to feel short of breath, and explains how calling 911 can lead to aggressive treatment they may not want.

“The biggest problem,” Diane says, “is that too many people with heart failure don’t know about the benefits of hospice. They need to understand how we can help them stay at home, and how much better they’ll feel when their symptoms are well managed by an experienced and knowledgeable hospice team.”

* The patient’s name has been changed for privacy.

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