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Donald P. Copley, M. D., a cardiologist practicing in Kenmore, favors home-based care for patients with chronic diseases.

MY VIEW

Home care is helpful for chronic heart failure

Updated: June 01, 2010, 6:27 am /
Published: June 01, 2010, 12:30 am

I peeked in the exam room to find Shirley radiant and well-dressed, flanked by her daughter. We congratulated each other on Shirleyís near-miraculous turnaround from what we all thought was end-stage heart disease.

I recalled a much younger woman who first came to me in 1987 because of chest pains due to heart artery spasms. Since then, Shirley and I have navigated several challenging medical crises, culminating last year in a string of harrowing hospitalizations for severe heart failure. Out of frustration from her lack of improvement, we opted last fall to start Hospice Buffalo home care, hoping for less distress in her remaining days with her family nearby.

I favored this approach because of my recent experience with a dozen of my sickest heart patients who were treated kindly and effectively by Hospice Buffalo in their homes. For two-thirds, the comfort they sought came with the daily attention provided by Hospice professionals. But more remarkably, the remaining third gained so much strength that they resumed everyday activities.

Over my 35-year career, Iíve seen hospitals take over the care of chronically sick heart patients, presuming this was the best approach. But recently Iíve seen hospital costs rise alarmingly without any increase in the quality of outcomes. Patients are frustrated by stressful and expensive hospital stays. I now believe quality health care at a reasonable cost requires at least some home-based care for patients with chronic diseases.

Heart failure has become the top cause of repeated hospitalizations, costing billions yearly. Chronic heart problems are particularly amenable to home care because symptoms such as shortness of breath and fluid retention are easy to manage at home. Because heart failure is unpredictable, itís better handled by a quick response team on call for home visits, rather than by hectic trips to hospital emergency departments.

Of course, home care should come into play only after conventional treatments such as angioplasty, surgery and pacemakers have been fully utilized.

My patients are reluctant at first to accept Hospice care, probably because of its connection with incurable cancer. But every one of my heart patients treated by Hospice Buffalo reported a favorable, even uplifting experience.

Iíve made a study of why Hospice works so well. It begins with its convincing optimism and unconditional commitment to a patientís well-being. I see an emphasis on what really counts: symptom relief, anxiety control, better nutrition, restful sleep and family closeness. Hospice professionals have a knack for harnessing a patientís own grit and determination, while amplifying assistance from family and friends.

Iíve seen a wide spectrum of expertise from its coordinated team of doctors, nurse practitioners, nurses, therapists, nutritionists and clergy. Hospiceís success comes from routine daily contact, punctuated by timely pinpoint adjustments in treatment, keeping patients symptom-free and away from hospitals. Iíve noted how it minimizes team personnel changes to avoid care lapses, resulting in greater patient confidence.

Thereís a clear lesson here for those of us seeking health care reform: Patients with ongoing diseases like chronic heart failure should be treated as much as possible at home by a team of experienced professionals if we ever hope to get a grip on rising health care costs. We must encourage simpler, scientifically proven, home-based protocols that amplify the inherent resources of family and friends.