Although it’s often thought of as a man’s problem, heart disease is the No.1 killer of women as well. That’s right, ladies. It’s not just breast cancer you need to worry about. Unfortunately, the signs of heart disease and heart attack in women can be different than those in men and are too often missed, making it even more deadly.
Even though heart disease prevails over cancer as the top killer, it still falls behind cancer as a reason for admission to hospice. A likely reason for this is that patients aren't always sure when palliative care is appropriate for their illness and, often times, neither are their doctors. Cancer is a disease that most patients fight full force until it’s obvious that the treatment is no longer working. Treatment for heart disease is more complicated.
Most patients with heart disease end up in a type of “revolving door” when it comes to treatment. Their symptoms get severe, they are hospitalized until their symptoms are stable, then discharged home until the symptoms worsen once again. They will continue in this cycle as their outcome becomes bleaker and are often not aware that there is another alternative.
Palliative care is a valid choice for many patients with severe heart disease who are experiencing distressing symptoms that are difficult to control. Symptoms of heart disease that may lead a patient to seek palliative care or hospice may include:
- Chest pain, or angina at rest
- Shortness of breath, or dyspnea at rest
- Persistent symptoms, such as edema or swelling, in the feet despite aggressive treatment
- Inability to tolerate aggressive treatments because of low blood pressure or kidney disease
- History of heart attacks and/or resuscitation
It's important to note, however, that many patients with distressing symptoms aren't necessarily getting the best possible medical care for their heart failure. Before considering palliative care, the patient should seek the advice of at least one and preferably two board-certified cardiologists. If these specialists deem that everything is being done to manage the heart failure and nothing is left to offer that will control their symptoms better or prolong their life, then palliative care may be an excellent choice.
Heart disease patients who choose comfort care have typically been through multiple hospitalizations and have decided that they want to avoid further ones. The palliative care team works with the patient and their caregivers to manage disabling symptoms. It’s a common myth that palliative and hospice care means giving up treatment. Patients typically stay on all of their heart medications as long as they can tolerate them, and new medications may even be started.
One of the more common medications that may be added once a patient is on palliative care or hospice for heart disease is morphine. This isn’t because the patient is terminal, which is a common misconception. Morphine is effective at treating shortness of breath, or dyspnea, which is a common symptom in advanced heart disease. It relaxes the chest wall muscles, dilates the blood vessels in the lungs and reduces the sensation of breathlessness in the brain. Other opiate pain medications, such as Methadone, may be substituted and work equally as well.
In addition to managing medications to optimize comfort, the palliative care team may recommend oxygen therapy if the patient isn’t already using it. They may also recommend having a hospital bed in the home to facilitate easier breathing while in bed. Raising the head of the bed reduces pressure on the lungs, making breathing more comfortable. Hospice agencies will always order any prescribed medications for comfort and any equipment needed, which are delivered directly to the patient.
If you’re considering palliative care for your heart disease or for someone you love, talk with your physician about the advantages and the potential disadvantages of hospice care as it relates to you personally.