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. His life had been extended by a left ventricular assist device, or LVAD (a battery-operated pump surgically implanted in patients with end-stage heart failure).

Even with his LVAD, Jermaine had just a few months to live. He enrolled in VNSNY Hospice and Palliative Care, where he was cared for by Diane K., his cardiac hospice nurse. Diane worked closely with Jermaine’s cardiologist, social worker, and other hospice team members. They helped him manage his LVAD and other issues related to his heart 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. “I tend to volunteer for different experiences,” says Diane, who’s been a hospice nurse for almost two decades.

VNSNY’s Cardiac Hospice Care Program

Diane has cared for a number of cardiac patients, and says that 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 has heart failure, they often fall into a cycle of repeated hospitalizations. Shortness of breath is common, so worried families rush their loved one to the emergency room. To avoid these unwanted trips to the hospital, Cardiac Hospice Care focuses on managing a patient’s heart failure symptoms at home.

Diane began teaching Jermaine and his family about his condition during her first visit. “We talk about where the patient would like to be as things start to change—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 coaches 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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