What is late stage congestive heart failure?

Stages of CHF

Heart failure or Congestive Heart Failure (CHF) is a disorder in which the heart cannot pump blood to the body at a rate sufficient to meet its needs or can do so only at the cost of high filling pressures.  Heart failure symptoms stem from two sources, fluid accumulation and reduced cardiac output. Fluid accumulation can results in dyspnea (shortness of breath), orthopnea (shortness of breath when lying flat), edema (fluid accumulation in the extremities) and ascites (fluid accumulation in the abdomen). Reduced cardiac output typically results in overall fatigue and weakness. Heart failure stages are most commonly classified using the New York Heart Association Classification.

• Class I: Patients with heart disease without resulting limitation of physical activity. Ordinary physical activity does not cause heart failure symptoms such as fatigue or dyspnea.
• Class II: Patients with heart disease resulting in slight limitation of physical activity. Symptoms of heart failure develop with ordinary activity but there are no symptoms at rest.
• Class III: Patients with heart disease resulting in marked limitation of physical activity. Symptoms of heart failure develop with less than ordinary physical activity but there are no symptoms at rest.
• Class IV: Patient with heart disease resulting in inability to carry on any physical activity without discomfort. Symptoms of heart failure may occur even at rest.

Prevalence and incidence of heart failure increases dramatically with age. Other conditions that increase the risk are: coronary artery disease, smoking, hypertension, obesity, diabetes and valvular heart disease. Risk modification is a key strategy in heart failure prevention.

When should we consider hospice care for CHF?

Hospice can be appropriate for many types of end-stage heart disease, including heart failure, valvular heart disease and coronary artery disease. Regardless of the type of heart disease, hospice is a fitting choice when an individual begins to experience persistent, severe symptoms that interfere with their daily life. Hospice care should also be considered if an individual begins to have recurrent hospitalizations or complicated hospitalizations, such as an ICU stay.

 One of the earliest symptoms of a declining heart is exercise intolerance. This begins with symptoms present with significant exertion and can progress to symptoms present with doing our activities of daily living, such as bathing and dressing. At its worst, symptoms are present at rest. Heart disease, depending on the etiology, can present with other more specific symptoms, including fluid overload, chest pain, lightheadedness, shortness of breath and arrythmias. Patients may experience unintentional weight loss despite a normal appetite. As the disease progresses, cardiac output can decline, resulting in low blood pressure and poor prefusion of our vital organs. This can lead to dysfunction of further organ symptoms, such as worsening kidney function.

According to the National Hospice and Palliative Care Organization, heart disease is on the rise in the United States. Additionally, the disease comes with a high symptom burden, specifically at the end-of-life. Therefore, individuals with end-stage heart disease and congestive heart failure (CHF) can benefit from hospice services.

Hospice of Southern Illinois focuses on comfort care for individuals with heart disease and CHF rather than curative treatment. Keeping in mind that your loved one’s wishes are most important, our team including the medical director, pharmacist, nurse practitioner, nurses, social workers, counselors, hospice aides and volunteers will work together to create an individualized plan of care to reduce pain and keep symptoms managed, including but not limited to, chest pain, shortness of breath and fatigue. We will cover medications, equipment and services related to the patient’s terminal prognosis. Contact us today for more information on hospice for CHF, care for individuals with heart disease, and care for advanced heart failure. No one has to go through the dying process alone. Hospice of Southern Illinois is here to help.

Is my loved one eligible for care? Here’s when to call hospice for heart failure, heart disease, and CHF.

• End-stage heart disease, advanced heart failure and congestive heart failure (CHF) symptoms to look for: chest pain, shortness of breath, cognitive decline, increased confusion, recurrent hospitalization for heart-related condition, treatment resistant dysrhythmias, fatigue, unintentional weight loss, significant limitations in physical activity, loss of appetite, anxiety, lightheadedness, fluid retention and/or swelling and increased sleeping.
• The presence of  other chronic disease or conditions such as diabetes or chronic pulmonary obstructive disease (COPD)  may also be a factor in determining eligibility for hospice care
• A prognosis of 6 months or less, if the disease takes its regular scientific course. No one really knows a definite timeframe.
• Curative treatment is no longer the patient’s choice or option. (Treatment is not always going to make a person better. Sometimes patients decide not to continue with expensive or experimental treatment options, but prefer to focus on quality of life and control of symptoms.)
• Comfort care, symptom management, and goals of care are the primary focus. (Oftentimes, pain is one of the most severe symptoms hospice can help manage. Hospice also helps treat wounds, evaluate medications, assist with personal care, and address emotional needs.)

How Does Hospice Manage These Symptoms

• All medications are reviewed upon hospice admission to ensure that they are contributing to relieving symptom burden. We also ensure that medications are reviewed with an eye looking for any triggers that could exacerbate symptoms. Often times, simple over-the-counter medications, such as ibuprofen, are often overlooked as contributors to edema in heart failure patients.
• Shortness of breath is treated in a multi-modality approach. We ensure diuretics are optimized to relieve fluid build up while maintaining patient safety as they may experience the need to use the bathroom more frequently. Nebulizer treatments may be added to aide with wheezing and cough. Oxygen can be placed in the home as a trial for a comfort measures with proper safety education occurring. We can also suggest bedside fans as a non-pharmacologic measure for many.
• Finally, morphine is an incredibly useful medication to treat shortness of breath, in addition to controlling pain. While morphine can be a worrisome step in a treatment plan for caregivers, we provide thorough education on its proper use and administration.
• Hospice patients often experience anxiety, certainly those with advanced heart disease. This can arise due to underlying shortness of breath or chest pain, or the anxiety can be a sole symptom in and of itself of declining cardiac function. Our social workers partner with our patients and families to talk through emotional and spiritual issues, and we can also provide anxiolytic medications to aide in symptom control.
• Edema, or fluid accumulation, is a common symptom of advanced heart disease. Medications designed at eliminating this fluid are often utilized. We also strive to ensure skin integrity and manage any wounds that may develop with a specialized palliative wound care program.

Supporting You and Your Loved Ones

A person-centered care model is how we approach caring for individuals and their families at the end-of-life. Hospice of Southern Illinois provides the personal care, attention and comfort during the final weeks and days of a loved one’s prognosis. We want to ensure your loved one’s comfort and dignity remains a priority. The circle of care for our patients starts with their needs and wishes and extends out to family, friends and caregivers. We are here to support and help you through what to expect too.

• Managing pain and other symptoms – we carefully monitor pain levels and other symptoms, coordinate proper equipment, and evaluate medications to provide as much comfort and peace as possible.

• Providing support – hospice offers regularly-scheduled visits from our care team to check in, provide education, listen, advocate, and explain what you need to know about the weeks ahead. Further, we offer emotional support to families along the way. Hospice care doesn’t stop there. For several months after the loss of a loved one, we continue to be available for bereavement support.

• Knowing what to expect – as the experts in end-of-life care, you can trust that we will work tirelessly to keep your loved one comfortable, supported and safe, all the while keeping you informed of any changes.

Safety in the Home

Caregivers are experiencing extreme challenges during the COVID-19 pandemic. We are ready to provide care in the home or home-like setting to ensure everyone’s safety. As an organization dedicated to providing exceptional care to the communities we serve, our uncompromising priority right now at Hospice of Southern Illinois is protecting our patients and families, our team members, and our community partners from exposure to coronavirus (COVID-19). Here’s what you can expect from us:

• Follow guidance from the Centers for Disease Control and Prevention (CDC) and the Illinois Department of Public Health
• Plenty of personal protective equipment (PPE)
• Increased education for families in their home or home-like setting
• Added telehealth services when face-to-face visits are not the best option
• The same person-centered care you’ve come to know and trust.

Call Hospice of Southern Illinois to learn more about end-of-life care and hospice services, 800-233-1708. Request a chat