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Hospice Care and Heart Disease

March 10, 2010

Heart failure, the condition in which the heart is unable to supply sufficient blood to meet the body's needs, currently affects nearly 5 million Americans and is the leading cause of hospitalization among Medicare beneficiaries. Despite advances in heart disease treatment, patients with advanced heart failure have a one-year mortality rate of 50 to 70 percent. Patients with end-stage heart failure may benefit from hospice care as they often suffer debilitating symptoms, including confusion and disorientation, nausea, weight loss, depression and unusual breathing patterns that reduce blood flow to areas of the brain that control breathing. Hospice promotes quality of life by providing professional medical care and symptom relief and is available to patients whose doctors determine that their life expectancy is six months or less. Hospice care focuses on managing pain and other symptoms, as well as the psychological, social and spiritual issues often experienced at the end of life. Hospice is a Medicare benefit; private insurance covers some or most hospice-related expenses. Even though hospice care is increasingly recommended for heart failure, it is underutilized—barely 12 percent of those in hospice care have heart failure. What’s more, hospice may be even less available to minorities. Building on previous studies that found racial differences in hospice use among cancer patients, a new study from the Institute for Aging Research of Hebrew SeniorLife and Boston University School of Medicine, published in the March 8 issue of the Archives of Internal Medicine, finds that blacks and Hispanics use hospice for advanced heart failure at a rate of up to 50 percent less than whites, despite a markedly higher rate of incidence of the disease in these populations because they have higher rates of diabetes and high blood pressure, two of the leading risk factors for heart failure. Previous studies of hospice have found that geography plays an important role, with patients living in areas with a greater number of minority residents having less access to hospice services. The Institute for Aging Research study took into account local patterns of hospice use and still found large racial differences in the use of hospice for heart failure. "Our findings document significant racial differences in hospice use and show that overall increases in the availability of hospice services in the 1990s have not erased racial differences in hospice utilization," says lead author Jane L. Givens, MD, MSCE, a scientist at the Institute for Aging Research. Dr. Givens says the study underscores the need to ensure that there is equal access to hospice services, as well as equal education about hospice, for racial and ethnic minorities. While studies show that cultural beliefs and values may play a role in the hospice-use difference, Dr. Givens says that hospice care must be culturally sensitive to be effective. To understand hospice care and determine if it appropriate for you or a loved one, see the articles in our Palliative Care Learning Center.