Home is Where the Heart Is: Experiences of an AHA-accredited Hospice Program

Key Message: As heart failure treatments become more sophisticated, patients increasingly enter home hospice with cardiac devices and inotrope infusions in place, requiring specialized hospice nursing skills, focused symptom management, and strong caregiver support. This case-based presentation will outline a hospice’s approach to meeting complex cardiac care needs at home.

Abstract: Healthcare innovation has provided many patients with end-stage heart failure with life-extending treatments and devices, including LVADs and inotrope infusions. However, many of these patients die in a hospital or other healthcare setting, with a significant gap in access to the comfort of home hospice care.
It is typical for fewer than 100 patients with LVADs to enter hospice care per year 1, compared to an estimated 546 patients with LVADs dying in the hospital per year, with larger estimates of 77% of all LVAD patients dying in the hospital 2,3 Similarly, patients on inotrope infusions are equally underserved in home hospice care and more likely to die in the hospital 4, rather than their preferred place of death. Long-term outcomes remain poor for patients discharged on palliative inotropes, with 1-year mortality rates ranging from 63% to 70% in recent US studies 5, highlighting the need for increased home hospice capabilities.
This session will explore the role of the National Partnership for Healthcare and Hospice Innovation’s Advanced Cardiac Care Program. Hospices can implement resources designed to increase awareness and address disparities in care for patients with advanced heart failure. By integrating organizational education, disease- and symptom-focused protocols, device-specific management, and multidisciplinary support for device discontinuation, hospices can be better equipped to care for complex patients in their homes rather than in a hospital.
A case-based presentation will illustrate the integration of skills and protocols for managing LVADs, inotropic infusions (milrinone and dobutamine), and symptoms, including a multidisciplinary approach to infusion or device discontinuation at home.

References: 1. Dunlay, S. M., Strand, J. J., Wordingham, S. E., Stulak, J. M., Luckhardt, A. J., & Swetz, K. M. (2016). Dying With a Left Ventricular Assist Device as Destination Therapy. Circulation. Heart failure, 9(10), e003096. https://doi.org/10.1161/CIRCHEARTFAILURE.116.003096
2. Nakagawa, S., Garan, A. R., Takayama, H., Takeda, K., Topkara, V. K., Yuzefpolskaya, M., Lin, S. X., Colombo, P. C., Naka, Y., & Blinderman, C. D. (2018). End of Life with Left Ventricular Assist Device in Both Bridge to Transplant and Destination Therapy. Journal of palliative medicine, 21(9), 1284–1289. https://doi.org/10.1089/jpm.2018.0112
3. McIlvennan, C. K., Grady, K. L., Matlock, D. D., Helmkamp, L. J., Abshire, M., & Allen, L. A. (2019). End of life for patients with left ventricular assist devices: Insights from INTERMACS. The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation, 38(4), 374–381. https://doi.org/10.1016/j.healun.2018.12.008
4. Eaton, R. E., Kissling, K. T., Haas, G. J., McLaughlin, E. M., & Pickworth, K. K. (2022). Rehospitalization of Patients with Advanced Heart Failure Receiving Continuous, Palliative Dobutamine or Milrinone. The American journal of cardiology, 184, 80–89. https://doi.org/10.1016/j.amjcard.2022.08.019
5. Sami, F., Acharya, P., Noonan, G., Maurides, S., Al-Masry, A. A., Bajwa, S., Parimi, N., Boda, I., Tran, C., Goyal, A., Mastoris, I., Dalia, T., Sauer, A., Bakel, A. V., & Shah, Z. (2022). Palliative Inotropes in Advanced Heart Failure: Comparing Outcomes Between Milrinone and Dobutamine. Journal of cardiac failure, 28(12), 1683–1691. https://doi.org/10.1016/j.cardfail.2022.08.007