Hospices Gear Up to Reach More Heart Failure Patients, Enhance Quality 

The incidence of end-stage heart failure is expected to rise throughout the next decade, and hospices are preparing to serve those patients when they become eligible.

The number of people who suffer from heart failure is expected to rise by 46% between 2012 and 2023, the American Heart Association (AHA) reported. However, hospice utilization remains relatively low for those patients.

As of 2020, those individuals represented only about 10% of Medicare decedents who elected hospice, according to the National Hospice and Palliative Care Organization (NHPCO).


Among the barriers to greater utilization are misconceptions among other providers about the nature of hospice and palliative care, Dr. Kristen Schaefer, vice president and associate chief medical officer at Care Dimensions, indicated.

“From a cardiologist’s perspective or a primary care clinician’s perspective, there are some stigma related to referral to hospice and palliative care,” Schaefer told Hospice News. “There’s still some lack of knowledge still about what the specialty is and what the services are.”

Care Dimensions is among the 15 hospice organizations to date that have secured the AHA’s Palliative and Hospice Heart Failure Certification. The certification is designed to provide an evidence-based framework for ensuring that a hospice’s care processes for heart failure are consistent with AHA guidelines and standards.


Though a growing body of evidence indicates that giving heart failure patients access to palliative care can improve outcomes, those services — as well as hospice — remain underutilized, a 2011 study in the journal Progress in Cardiovascular Illness found.

Contributing factors include a generally poor understanding of palliative therapies, the complexity of determining a prognosis and inexperience with end-of-life issues among caregivers, the study showed.

Schaefer, who is also chair of the oversight committee for the AHA certification program, said that adherence to a consistent set of guidelines can help foster trust and collaboration with referral partners.

“We then really raise the level of collaboration across specialties between hospice and palliative care, cardiology and primary care. Our patients and families need their teams to be talking with each other, to have a shared language about decision making, goals of care and symptom management in the final stages of heart failure,” Schaefer said. “Really knowing the clinical practice guidelines and national standards is a point of quality for the cardiology and primary care sides, for them to be able to have a hospice and palliative care team that understands and is working within the same standards.”

The program focuses on six key areas: program management, personnel education, patient and caregiver education and support, care coordination, clinical management and performance improvement.

Recently, the Chemed Corp. (NYSE: CHE) subsidiary VITAS Healthcare received the certification for its Atlanta locations. This was a “rigorous” six-month process, according to Nick DeRosa, sales strategy and analysis lead for VITAS.

Heart disease is the leading cause of death in Fulton County, Georgia, which includes Atlanta, VITAS Vice President of Operations Jennifer Nygaard told Hospice News. This made it a priority market for the certification, she said.

Aligning its existing heart failure programs with the AHA certification standards sends a message to referral partners as well as patients and families, according to DeRosa.

“Patients and partners in Atlanta can be confident that we’re providing heart failure services that have been carefully planned for every step of the care pathway,” DeRosa told Hospice News. “Earning this certification is a strong indication to our partners over the level of detail that has gone into creating our heart failure services.”

Behavioral Health Business Editor Laura Lovett contributed to this report.

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