HOSPICE HEART DISEASE                      

 

At the time of initial certification or re-certification for hospice

Patient is already optimally treated with diuretics and vasodilators, which may include
angiotensin-converting enzymes (ACE) inhibitors or the combination of hydralazine and nitrates. If side effects, such as hypotension or hyperkalemia, prohibit the use of ACE inhibitors or the combination of hydralazine and nitrates, this must be documented in the medical records OR

Patients having angina pectoris, at rest, resistant to standard nitrate therapy the patient has significant symptoms of recurrent congestive heart failure (CHF) at rest, and is classified as a New York Heart Association (NYHA) Class IV:

Unable to carry on any physical activity without symptoms

Symptoms are present even at rest

If any physical activity is undertaken, symptoms are increased

Documentation of the following factors may provide additional support for end stage heart disease:

Treatment resistant symptomatic supraventricular or ventricular arrhythmias

History of cardiac arrest or resuscitation

History of unexplained syncope (A brief loss of consciousness caused by a temporary deficiency of oxygen in the brain; a swoon, blackout.)

Brain embolism of cardiac origin

Concomitant HIV disease

Documentation of ejection fraction of 20% or less

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