5 Most Dangerous Trends in CHF.

1. 5 Most Dangerous Trends in CHF.

2. Researched and produced by: Sponsored by:

3. Why did we commission this study? • 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!

4. Areas Covered • 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..

5. 5 Most Dangerous Trends: • Baby Boomers flooding the system • Unclear patient and family expectations with HF • More acute health co-morbidities • Longer life expectancy • Higher cost-of-care

6. Did you know? There are approximately 5.3 million people suffering from congestive 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.

7. Did you know? The number of patients with CHF discharged 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

8. Every year there are approx. 550,000 new cases of CHF Patients in the U.S. • 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.

9. The Silver Tsunami • 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. RS

10. 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)

11. Our Future Geriatric Population Life Expectancy ER Visits

12. 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. End – Stage CHF: Suffering Undertreated / Under recognized Severe symptoms in last 48-72 hours prior to death: • Breathlessness 66% • Pain 41% • Confusion 15% • Dyspnea 50% • Depression 59% • Anxiety / Fear 45%

15. End of Life Care Planning & Goals AIDS: 52% Cancer patients: 47% HEART FAILURE: 5% 23% wanted DNR

16. Current Model of End of Life Care Aggressive / Curative Treatment Hospice Care Bereavement JG

17. A Better Option Palliative /Concurrent Care Disease-Modifying Treatment Hospice Care Palliative Care CURATIVE Bereavement Support HEALING Terminal Illness Death

18. Results of Palliative Care 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. • Medical Director • Nurses • Social Workers • Chaplains • Counselors

19. Studies in the News Palliative Care Extends Life, Study Finds By DONALD G. McNEILJr. Published: August 18, 2010 Palliative Care Can Extend Life 2010 Palliative Care Early On Has Many Benefits Published inJournal Watch General MedicineSeptember 30, 2010 Palliative care prolongs life, reduces suffering March 2007

20. Barriers to Palliative Care • 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

21. Did you know 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.

22. IN HOME Palliative Care Offers Specialized, State of the Art Care Plans for: • Pain • Edema • Nausea • Dyspnea • Non-Compliance • Altered Physical Mobility • Spiritual / Psychosocial Needs • Agitation / Depression / Anxiety • Delirium & Cognitive Difficulties • Alteration in family coping / management • Knowledge of Disease Process / Caregiver Preparations (DNR) RS

23. 5 Steps to Improving Patient Care • Partner with an in home Palliative Care Provider. • Clearly define & redefine patient’s goals for care. • Focus on educating caregivers as well as patients on disease progression. • Reinforce symptom control management and self care. • Set realistic expectations.

24. VISION: Create Strong Partnership with single, continuity providers to Offer Full Range of Coordinated, Clinical Services to Patients. • Initial Goals: • Seamless & Integrated Services • Convenience for Patients & Families • Minimize Hospitalization • Decrease exacerbations • Increase QOL • Services: • Strategic Partnerships • In-Home Physician / NP visits routine. • Call P.C. provider before 911 • Initiate & F/up Care plans • Disease education / Crisis Control Interventions

25. Palliative Care Partnership

26. And Now A Word From The Sponsor JG

27. South Carolina’s only House Calls Geriatric Wellness System

28. 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.  

30. Our Commitment Providence is not a replacement of your care, it’s a complement that will: • Communicate with you regarding your patients’ progress. • Consistently update you with any care plans initiated as well as medication updates. • Conduct ourselves in an ethical and respectful manner. • Serve with an attitude of unselfish concern. • Meet the needs and strive to exceed the expectations of those we serve through continuous improvement. • Constantly explore, study and develop new concepts and opportunities.

31. Who To Refer Today • 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. RS

32. QUESTIONS / COMMENTS

33. References • 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.