5 Most Dangerous Trends in CHF.

Researched and produced by:

2

Sponsored by:

Heart Failure and the co-morbidities that result are dramatically changing healthcare and provider requirements.

As South Carolina’s only Geriatric Wellness System, we serve hundreds of these patients and are profoundly affected by their stories.

In an attempt to provide greater value for patients and their families, we commissioned an independent research firm to investigate these trends. We are pleased to bring this informative presentation to

you!

Why did we commission this study?

3

Latest Baby Boom Trends

Exposing the 5 biggest challenges of caring for the aging HF generation.

Discovering 1 KEY step to decreasing workload and improving your patients’ quality of life..

Areas Covered

5 Most Dangerous Trends:1. Baby Boomers flooding

the system

2. Unclear patient and family expectations with HF

3. More acute health co-morbidities

4. Longer life expectancy

5. Higher cost-of-care

Did you know?There are approximately 5.3 million people suffering fromcongestive heart failure (CHF) in the United States.

The lifetime risk of developing heart failure at the age of 40 is 20%, and approximately 380,000 people above the age of 65 will be diagnosed with CHF annually.

Did you know?The number of patients with CHFdischarged from the hospital rose from 400,000 in 1979 to over 1 million in 2005.

Within 4-6 months after discharge 47% of the patients are likely to be readmitted.

The five year mortality rate for patients with CHF was 48% from 1996-2000

The total annual cost of caring for CHF in the U.S. is more than $30 billion, with 60 percent associated with hospitalization.

The costs of CHF hospitalizations typically exceed reimbursement, as the expenses associated with long length of stay quickly overwhelm the $6,000 average reimbursement provided by Medicare.

Palliative Care services decrease these costs drastically.

8

Every year there are approx. 550,000 new cases of CHF Patients

in the U.S.

According to the SC Department on Aging, there are currently 800,000 (20%) seniors in SC alone. This amount is expected to double to 1.9 million by 2030.

Baby Boomers are retiring at an average rate of 10,000 a day.

In 2000, there were 4.2 million Americans age 85 or older. By 2030, nearly 9 million Americans will be over the age of 85.

This aging population will increase the demand for primary, geriatric, palliative and end-of-life care for patients with chronic disease.

THE SILVER TSUNAMI

9RS

A Study Found More than 6 of every 10 Boomers will be managing more than one chronic condition. (COPD, CHF, Diabetes)

More than one out of every three Boomers – over 21 million – will be considered obese.

(THIS WILL INCREASE FALL RISKS AND ER VISITS)

10

Our Future Geriatric Population

ER Visits

Life Expectancy

It’s Easier to die from Cancer than HF….. John Hinton MD 1963

PANIC

13

Hospitalizations only improve symptoms in 35-50% of the cases

40% of patients dying of Cancer get palliative care (Only 4% for HF patients)

54% of patients were predicted to have a prognosis of 6 months or more however patients died within 3 days

14

Severe symptoms in last 48-72 hours prior to death:Breathlessness 66%Pain 41%Confusion 15%Dyspnea 50%Depression 59%Anxiety / Fear 45%

End – Stage CHF:Suffering Undertreated / Under recognized

AIDS: 52%

Cancer patients: 47%

HEART FAILURE: 5%

23% wanted DNR

15

End of Life Care Planning & Goals

16

Aggressive / Curative Treatment

Hosp

ice

Care

CURRENT MODEL OF END OF LIFE CARE

Ber

eave

men

t

JG

17

Disease-Modifying Treatment

Hospice Care

Bereavement SupportPalliative Care

DeathTerminal Illness

A Better OptionPalliative /Concurrent Care

CURATIVE

HEALING

Studies has proven that the Interdisciplinary approach to Palliative Care can help to reduce HF symptoms and exacerbations while increasing quality of life and life expectancy.

Results of Palliative Care

Medical DirectorNursesSocial WorkersChaplainsCounselors

Studies in the News

19

Palliative Care Extends Life, Study FindsBy DONALD G. McNEIL Jr. Published: August 18, 2010

Palliative Care Can Extend Life 2010

Palliative Care Early On Has Many Benefits Published in Journal Watch General Medicine September 30, 2010

Palliative care prolongs life, reduces suffering March 2007

20

• Concern of “Losing Patient”

• Prognostication difficult (Disease trajectory / When to Refer)

• Perceived inability of palliative care to manage complex care

• Perception that all meds must be d/cd

• Sense of “Giving Up” on your patient

Barriers to Palliative Care

Provides care in the relief of pain and other stressing symptoms.

Works with your current treatments not in lieu of.

Affirms life

Reduces hospitalizations

Focuses on Healing.

Intends neither to hasten nor postpone death.

Offers a support system to patients (and caregivers) to help patients live as actively as possible until death.

Did you know Palliative Care

21

Specialized, State of the Art Care Plans for:PainEdemaNauseaDyspneaNon-ComplianceAltered Physical MobilitySpiritual / Psychosocial NeedsAgitation / Depression / AnxietyDelirium & Cognitive DifficultiesAlteration in family coping / managementKnowledge of Disease Process / Caregiver Preparations

(DNR)

IN HOME Palliative Care Offers

RS

5 Steps to Improving Patient Care1. Partner with an in home

Palliative Care Provider.

2. Clearly define & redefine patient’s goals for care.

3. Focus on educating caregivers as well as patients on disease progression.

4. Reinforce symptom control management and self care.

5. Set realistic expectations.

Initial Goals:1. Seamless & Integrated

Services2. Convenience for Patients &

Families3. Minimize Hospitalization4. Decrease exacerbations 5. Increase QOL

VISION: Create Strong Partnership with single, continuity

providersto Offer Full Range of Coordinated, Clinical

Services to Patients.Services:1. Strategic Partnerships2. In-Home Physician / NP

visits routine.3. Call P.C. provider before

9114. Initiate & F/up Care

plans5. Disease education / Crisis

Control Interventions

YOUR VISIT AND CARE

Palliative Care visit AT PATIENT’S

HOME

Care PlanGoals /

Education Better clinical

outcomes

Increased QOL& Life

Expectancy

Palliative Care Partnership

25

And Now A Word From The Sponsor

JG

South Carolina’s only House Calls Geriatric Wellness System

Currently serving over 600 patients, we specialize and tailor care for chronic & terminally ill patients suffering CHF symptoms.

 

Palliative care is the active total care of your residents whose disease or symptoms may or may not respond to curative treatment. The goal of palliative care is to prevent and relieve suffering and to support the best quality of life for residents and their families, regardless of the stage of the disease or the need for other therapies. Unlike hospitals and clinics we bring our palliative care physicians and NPs to you and care for the patient in their home setting.     

Providence is not a replacement of your care, it’s a complement that will:

1. Communicate with you regarding your patients’ progress.

2. Consistently update you with any care plans initiated as well as medication updates.

3. Conduct ourselves in an ethical and respectful manner. 4. Serve with an attitude of unselfish concern. 5. Meet the needs and strive to exceed the expectations

of those we serve through continuous improvement.6. Constantly explore, study and develop new concepts

and opportunities.

Our Commitment

Those patients deemed two years or less of life expectancy.

Frequent hospitalizations.

Highly symptomatic/ refractory patients usually NYHA Class III/ IV patients

Those with non-compliance.

Caregiver breakdown.

Who To Refer Today

31RS

32

QUESTIONS / COMMENTS

References

33

Adler ED et al. Palliative Care in the Treatment of Advanced Heart Failure. Contemporary Reviews in Cardiovascular Medicine. Circulation 2009; 120:2597-2606.

American Heart Association. Heart Disease and Stroke Facts, 2006 Update. Dallas, Texas: AHA, 2006.

American Hospital Association. How Boomers Will Change Health Care, 2007. Chicago, Illinois: AHA, 2007

Esciencenews.com. Remote Monitoring Improves Heart Failure Patients’ Health, 2008. Framingham Heart Study. Lifetime Risk For Developing congestive heart failure: 2002 Dec

10;106(24):3068-72. Goodlin, SJ. Palliative Care in Congestive Heart Failure. Journal of the American College of

Cardiology, 2009; 54:386-396. HemaniS et al. Providing Palliative Care in End-Stage Heart Failure. Journal of Hospice and Palliative

Nursing, 2008; 10(2):100-105. Hupcey, JE et al. Heart Failure and Palliative Care: Implications in Practice. Journal of Palliative

Medicine, 2009 June; 12(6):531-536. Jaarsma, T et al. Palliative Care in Heart Failure: A Position Statement from the Palliative Care

Workshop of the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure, 2009; 11:433-443.

McNeil Donald G. Jr. et al. Palliative Care Extends Life. New York Times, August 18, 2010. Pyenson, Bruce. Palliative Care prolongs life, reduces suffering. Journal of Pain and Symptom

Management, 2007. South Carolina Department on Aging, Statistics, 2010. Columbia, South Carolina: 2012. Selman L et al. Improving End-Of-Life Care for Patients With Chronic Heart Failure. Heart, 2007;

93:963-967. Unroe, KT et al. Resource Use in the Last 6 Months of Life Among Medicare Beneficiaries With Heart

Failure, 2000-2007. Archives of Internal Medicine, 2011; 171(3):196-203. Zuger, Abigail, MD et al. Palliative Care Early On Has Many Benefits. Journal Watch, September 30,

2010.