Hospice Care for End Stage Heart Failure – Quality of Life

If you or a loved one is struggling with the symptoms of heart failure, hospice care can significantly improve the quality of your life.

It is projected that nearly 5 million people in the United States are affected by Congestive Heart Failure.  The National Hospice and Pallative Care Organization reports that heart failure is one of the three most common diagnoses for hospice care, next to Cancer and Dementia.

What is Heart Failure?

Formally known as Congestive Heart Failure or CHF, this is a condition where the heart muscle is weaker, and it is no longer pumping as well it may once have.  The heart is a beautiful, intricate organ,  and very mechanical in function.  The following video is a very nice synopsis of how the heart works.

What causes the heart muscle to be weakened?

There are several conditions that contribute to a weakened heart. A heart attack can greatly increase the risk of causing irreversible damage.  The heart muscle demands a certain level of oxygen, and if it does not get enough, it will squeeze very tightly.  This is a warning sign that the heart is deprived of oxygen.  This could potentially lead to long term damage to the muscle, or even stop the heart all together.

Heart disease is the leading cause of death in men and woman.   The heart itself is essentially a mechanical organ, and over time it begins to show wear and tear.  It is expected that heart disease will most likely damage the heart muscle over time, as a progression of aging.   There are many factors and genetics that contribute to heart disease.  The lifestyle choices that someone makes can influence the disease process.

 How is Heart Function Measured?

Most specifically heart function is best measured by the value referred to as the Ejection Fraction or EF.   There are several types of imaging tests that can be used to help determine someone’s ejection fraction.  A more common test, that the doctor may order, is an Echocardiogram.  This is an ultrasound, and is a relatively non-invasive procedure that can be very telling about the state of someone’s heart function.

In a healthy heart that is functioning well, the EF is generally higher than 55%.  If the disease is detected early, then someone may live with the illness for many years.  Adopting healthy lifestyle habits may slow down the progression. When an EF in less than 20%, that individual may be struggling with the symptoms associated with congestive heart failure.  In this circumstance, hospice can potentially provide you and your loved ones with a great deal of assistance.

What is considered End Stage Heart Failure?

Your doctor will determine which class a patient falls into in regard to the progression of heart failure.  Very commonly used is a functional scale, established by the New York Heart Association which consists of four classes.

  • Class I – This represents the early stage of disease process, and the patient is able to tolerate normal levels of physical activity without experiencing fatigue or shortness of breath.
  • Class 2 – Typically the patient is fine while at rest, but may experience some mild symptoms of fatigue or shortness of breath with ordinary types of physical activities.
  • Class 3 – This is progression of heart failure when someone now is not tolerating a lot of physical activity.  This individual may require frequent rest periods with walking and activity, but still remains pretty comfortable while in a resting state.
  • Class 4 – The final stage of heart failure is when the  disease has progressed to the point when someone is starting have severe shortness of breath or chest pain with any type of physical exertion.  Someone in the functional class will often need a lot of assistance with day to day activities, and often times will experience  shortness of breath while resting.

If you or your loved one is suffering from a Class 4 Stage of Congestive Heart Failure, hospice care can help.

According to a study published in the Journal of Pain and Medicine, in some cases a person may live longer on hospice than not.  When these patients are being treated aggressively for their symptoms, they often find themselves in a vicious cycle of needing care at a hospital level.

Our health care approach to the treatment of heart failure has some flaws.  The standard of care for patients with heart failure is lacking.  These patients will see their doctor maybe every three months, and expected to manage their medications and care independently.  Often times, these individuals will suffer from chronic shortness of breath and fatigue.  When the symptoms become unbearable, their only option is seek care at the emergency room.  This triggers hospitalizations for several days at a time.  The hospital doctors will treat the patient’s symptoms aggressively.  Their main goal is to try to remove the excess fluid in the bloodstream, responsible for overworking the heart.  A typical hospitalization course is about 3-5 days, and can be rigorous.   Unfortunately during that hospital stay, nothing was done to make the patient’s heart stronger.  The doctor at the hospital is only putting band aids on a broken heart.  Most likely these patients will go home, and the band aids will start to leak, and they find themselves back in the hospital once again for more band aids.

When this yoyo effect with hospitalizations begins to occur, you or loved one are most likely eligible to receive hospice services.

How Can Hospice Make a Difference?

Patients are Monitored More Closely.

When someone is started on hospice care, the Nurse Case Manager will be routinely seeing them in their home.  With a nursing visit 1-2 times a week, it allows for close monitoring and prompt medication adjustments under the supervision of the hospice doctor.

Increased Support with Prescription Medications.

Hospice will pay for all of the medications that are related to heart disease under the direction of the hospice doctor.  In addition, they will provide all necessary medications that may be needed to manage symptoms or provide comfort.  This often includes over the counter medications to treat pain, heartburn, or constipation for example.

The hospice nurse will guide the patient and their loved ones on how to medications safely.  Someone will always be available to you 24 hours a day, if you were to have questions or need assistance with medications.

It is Much Easier to Get Needed Equipment.

Medicare is pretty strict with their allocation of who is eligible for home oxygen therapy.   Therefore, it can be challenging as a heart failure patient to qualify for it.  The benefits of having supplemental oxygen available can be quite significant, and can even slow down the disease.  Most patients will be issued an oxygen concentrator by the hospice doctor at the start of their care, at no cost to the patient.

A hospital bed can be helpful if someone is having a hard time sleeping lying down.  These patients will report restless nights due to inability to get in a comfortable position.  Very commonly these patients will start napping during the day in the recliner.  Being able to elevate the head of the bed can be very beneficial for those suffering from shortness of breath.  Medicare pays 100% for all the equipment necessary to provide the care for you or your loved one.

I hope that you found this information helpful.  Please feel free to leave a question or comment.


  • Steve July 21, 2017 at 3:52 am

    What a great site! So easy to follow and so thorough that I breezed through it, with lots of take aways. My dad had hospice care at the end of his fight with cancer and it was great. Today, my mother has heart failure, and sleeps sitting up, just as you explained. This is very helpful information to me. Many thanks!

    • Heather Williams RN CHPN July 21, 2017 at 6:19 pm

      Thank you Steve. I am glad that you found the information useful. I am sorry for the loss of your father, and I am relieved that hospice was able to help out. Best of luck to you and your mom.
      Take Care,

  • Mia July 21, 2017 at 10:57 pm

    This website seems very helpful for any person that needs good advice and information about hospices. It can be really difficult to deal with these situations on your own, so having a website that can help you with this I think is a really good thing, Thanks for wanting to help other!

  • Cheryl July 22, 2017 at 1:40 pm

    Hi Heather, thank you for a very good and informative page. It has lots of very good and detailed information and would most certainly be a good help for someone to read that maybe has the fear of going into hospice care. I really liked reading your article and I would direct anyone who has any fears about these things to your site.

    • Heather Williams RN CHPN July 22, 2017 at 2:36 pm

      Thank you Cheryl for your comment. My hope with the information is help to remove some of the fear that is associated with hospice care. We are about living and quality of life despite setbacks.
      Take Care, Heather

  • alifedesignbyme July 22, 2017 at 1:54 pm

    Very useful information and the way it is structured and redacted is great. The reading was interesting and dynamic… Good job.
    I don’t have this problem but it is wonderful that people who do, have this kind of support and knowledge. We are here to help others and I love to find blogs so caring and helpful. Congratulations!

    • Heather Williams RN CHPN July 22, 2017 at 2:38 pm

      Thank you very much. I think we as human beings have a moral obligation to help out our fellow man. I am very happy that you found this information beneficial.
      Take Care, Heather

  • Roopesh August 6, 2017 at 9:28 am

    My father in law had a heart attack around 6 months ago.It seems that now his condition is getting worse.

    The doctors have had to see to him on more than 3 three occasions since his first attack. We as a family had discussions on whether or not to follow the hospice route.

    As you said, the cycle will just repeat itself, should we leave it this way. It is about the quality of life and you have brought up some interesting points that we need to consider.

    Rest assured, your post had given me peace of mind and we are easier with going along with the decision.

    Thanks for all the help

    • Heather Williams RN CHPN August 7, 2017 at 5:46 pm

      Thank you Roopesh. I am so pleased that this information was helpful and gave you some peace of mind. It is difficult to watch the people we love, for them to not be able to do the things that they once did. Rest assured there are many compassionate hospice caregivers available to support your dad and everyone in your family, when the time comes. Take Care, Heather


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