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case_report·cardiology, geriatrics, family medicine, internal medicine·PMC10314144

Alternatives to Hospitalization: Adding the Patient Voice to Advanced Heart Failure Management

CJC Open · 4 authors, 2 centres

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TL;DR

This narrative review and case report discusses strategies to help advanced heart failure patients avoid hospitalization and remain at home, based on a patient's goals, pharmaceutical interventions, and integrated care models.

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853 CHARS

This paper is a narrative review accompanied by a case report of a 79-year-old female with advanced heart failure. The authors outline a framework for avoiding hospitalization, including comprehensive goals-of-care discussions to identify suitable patients, pharmaceutical interventions to manage symptoms like diuretic resistance, and robust home-based care models. The case illustrates a collaborative approach using intensified oral diuretics, oxygen, and low-dose opioids, which enabled the patient to remain at home until the end of life. Limitations include the need for major health system change to implement alternative care models, a general lack of randomized trial evidence, and unvalidated diuresis protocols. The authors conclude that further research is needed to reduce hospitalization rates and advocate for person-centred care systems.

STUDY TYPE

case_report

SPECIALTY

cardiology

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AI pipeline

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100% · A

ORIGINAL PAPER

PMC10314144

Alternatives to Hospitalization: Adding the Patient Voice to Advanced Heart Failure Management

CJC Open

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ABSTRACT

Advanced heart failure (HF) is associated with the extensive use of acute care services, especially at the end of life, often in stark contrast to the wishes of most HF patients to remain at home for as long as possible. The current Canadian model of hospital-centric care is not only inconsistent with patient goals, but also unsustainable in the setting of the current hospital-bed availability crisis across the country. Given this context, we present a narrative to discuss factors necessary for the avoidance of hospitalization in advanced HF patients. First, patients eligible for alternatives to hospitalization should be identified through comprehensive, values-based, goals-of-care discussions, including involvement of both patients and caregivers, and assessment of caregiver burnout. Second, we present pharmaceutical interventions that have shown promise in reducing HF hospitalizations. Such interventions include strategies to combat diuretic resistance, as well as nondiuretic treatments of dyspnea, and the continuation of guideline-directed medical therapies. Finally, to successfully care for advanced HF patients at home, care models, such as transitional care, telehealth, collaborative home-based palliative care programs, and home hospitals, must be robust. Care must be individualized and coordinated through an integrated care model, such as the spoke-hub-and-node model. Although barriers exist to the implementation of these models and strategies, they should not prevent clinicians from striving to provide individualized person-centred care. Doing so will not only alleviate strain on the healthcare system, but also prioritize patient goals, which is of the utmost importance.

CITATION EXPORT

Hilary J. Bews, Jana L. Pilkey, Amrit A. Malik et al.. Alternatives to Hospitalization: Adding the Patient Voice to Advanced Heart Failure Management. CJC Open. (2023). https://doi.org/10.1016/j.cjco.2023.03.014

AUTHORS

4 · 2 CENTRES

Hilary J. Bews, Jana L. Pilkey, Amrit A. Malik, James W. Tam

aSection of Cardiology, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
bSection of Palliative Care Medicine, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada