Hospices, and the larger health care system, can do more to ensure that patients with cardiovascular diseases receive quality end-of-life care.
This is according to Dr. Heather Veeder, regional medical director for VITAS Healthcare, a subsidiary of Chemed Corp. (NYSE: CHE). Heart disease patients are under-represented among hospice recipients, and often come into care too late to reap the full benefits, Veeder said.
“Hospice is really underutilized for patients with cardiac disease. A lot of patients never get to hospice, and then oftentimes those that do enroll in hospice later than they could,” Veeder told Hospice News. “I think it’s due to there’s uncertainty in that disease course. It’s very much an up-and-down disease course, and so that can make prognosis difficult to determine.”
Delays in having goals-of-care conversations can also impact the timing of when a patient comes to hospice, Veeder said.
Cardiovascular disease (CVD) remains the world’s leading cause of death, according to the U.S. Centers for Disease Control and Prevention (CDC). These ailments were responsible for about 19.8 million deaths in 2022, or roughly 32% of all global mortality.
In the United States, someone dies from CVD approximately every 34 seconds, totaling nearly 920,000 deaths in 2023, CDC reported. About half of U.S. adults live with some form of cardiovascular disease, largely linked to risk factors such as high blood pressure, excess body weight and smoking.
Nevertheless, hospice utilization among cardiac disease patients remains relatively low, compared to diagnoses like cancer or dementia-related illnesses.
Heart patients represented 12.7% of hospice patients in 2024, according to the National Alliance for Care at Home. That percentage is for six specific cardiovascular-related diagnoses combined.
Health care providers can better serve cardiovascular disease patients by facilitating earlier goals-of-care conversations, Veeder said. Patients and families also need education about the nature of hospice and what providers can do for them.
When appropriate, hospice can help stabilize these patients by managing their severe and complex symptom burden and preventing avoidable hospitalizations. Hospices can also help care for the family and reduce the often extreme strain on caregivers, she indicated.
“Hospice is the answer to a lot of the problems in our health system. [The health care system] provides so much care in the United States that isn’t helpful and can often be harmful to people that are near the end of life” Veeder said. “People need to know about hospice, and they also need to know where they are in their disease course. It’s making sure that we have strong relationships with the hospitalists, with the cardiologists, with the primary care physicians. It is participating in getting the word out there, and participating in goals-of-care discussions and allowing people to make as informed a decision as they can.”
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