In this episode, we take a thoughtful, practical look at a topic that’s often misunderstood: hospice care. Whether you’re a clinician, caregiver, or simply someone trying to navigate the complexities of serious illness, this episode offers clarity on what hospice really is—and isn’t.

We cover:

• What hospice care truly entails from a clinical and insurance perspective
• The full range of support services patients receive under hospice, from 24/7 clinician access to spiritual care and medical equipment at home
• How to identify patients who may benefit from hospice earlier in their disease course
• How to approach compassionate, honest conversations with patients and families when curative treatment is no longer the goal

We also explore tools like the “Surprise Question” and the Serious Illness Conversation Program (SICP) that can help guide clinicians through these critical moments.

With nearly 70% of Americans wishing to die at home—but only 30% doing so—we discuss how timely hospice enrollment and skilled communication can help align care with what patients truly value: comfort, dignity, and peace.

In this fourth installment of our heart failure series, we dive into another essential pillar of guideline-directed medical therapy (GDMT): the renin-angiotensin system (RAS) inhibitors. This includes ACE inhibitors, ARBs, and ARNIs—cornerstones of treatment for patients with heart failure with reduced ejection fraction (HFrEF).

Join us as we unpack how RAS inhibitors work, when to initiate therapy, and how to navigate clinical decision-making around switching, tolerability, renal function, and blood pressure thresholds. We also discuss practical considerations for initiating or holding therapy during acute kidney injury (AKI) and the evidence-based rationale for continuing these agents even with declining GFR.

Whether you're managing complex patients in the SNF, at home, or via telemedicine, this episode offers clear, clinically grounded insights to optimize care.

In this episode of Key Perspectives, we continue our heart failure series by diving into Part 3: Medication Management, with a focus on spironolactone, a cornerstone of guideline-directed medical therapy (GDMT).

We start by reviewing the distinctions between HFpEF, HFmrEF, and HFrEF, and discuss how treatment strategies differ across these subtypes. The hosts explain what GDMT is, who develops it, and why it's essential in improving outcomes and reducing hospitalizations in heart failure patients.

The spotlight is on spironolactone—its dual role in HFrEF and HFpEF, its mechanism as a mineralocorticoid receptor antagonist, and how it contributes to diuresis, cardiac remodeling prevention, and potassium-sparing benefits. We also cover clinical pearls, including when it can be used alongside loop diuretics like Lasix, and important considerations for avoiding use in patients with hyperkalemia or poor renal function.

Tune in for a concise, clinically relevant discussion that enhances your understanding of heart failure pharmacology and supports your practice in geriatric and complex patient care settings.