Pre-Hospice Cardiac Clearance Recommended By American College of Cardiology.

Nashville, TN  --  The American College of Cardiology (ACC) created havoc Wednesday with  a landmark position paper recommending all patients considering hospice undergo pre-hospice cardiac clearance prior to initiating comfort care measures.  The College's expansion into pre-hospice evaluations coincides with Medicare's announcement of another 20% cut in reimbursement for cardiac services by 2016.

"While the A.C.C. doesn't have any hard data to prove this hypothesis, we believe hospice candidates who undergo thorough cardiac clearance prior to starting a comfort care program will really appreciate knowing their ejection fraction, the health of their heart valves, whether they are at risk for myocardial infarction  and the potential for any rhythm issues that could complicate their hospice program," said Raj Chopra, M.D, M.P.H, F.A.C.C, Chair of the Task Force on Clinical Expert Consensus Documents.

Position publications by medical societies often provide support for their members  despite a lack of strong clinical research to base their conclusions.  Many position papers contain low grade evidence or expert opinion that becomes standard of care in many communities.

"We actually prefer publishing position papers using expert opinion rather than Grade A evidence because, to the lay physician,  having the word 'expert' in the paper carries more weight," said Raj, a self proclaimed expert in the benefits of end-of-life pacemaker therapy.

Because hospitalists are frequently involved with palliative care decisions, the A.C.C. has been working closely with The Society of Hospital Medicine (SHM) to disseminate continuing medical education modules on pre-hospice cardiac clearance.  In return for their support, S.H.M. is begging A.C.C. members to stop publishing cardiac studies with acronyms that spell out words.

"The acronyms used to be cute, but now they're just annoying," said one SHM board member, who wished to remain anonymous.

The American Academy of Hospice and Palliative Care responded by recommending patients considering hospice rip off their telemetry and play dead already if any cardiologist came to their hospital room.



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