Heart diseases

Heart Disease

Patients will be considered to be in the terminal stage of heart disease if they meet the following criteria: 1 and 2 should be present; factors from 3 will lend supporting documentation:

• At the time of initial certification or recertification for hospice:
• •The patient is or has already been “optimally treated” for heart disease or is not a candidate for a surgical procedure or has declined a procedure. (Optimally treated means that patients who are not on vasodilators have a medical reason for refusing these drugs or the drugs are no longer working, e.g., hypotension or renal disease.)


• The patient is classified as New York Heart Association (NYHA) class IV and may have significant symptoms of heart failure or angina at rest.
• • Inability to carry on any physical activity without discomfort.
• • Symptoms of heart failure or of the anginal syndrome may be present even at rest.
• • If any physical activity is undertaken, discomfort is increased.


• Documentation of the following factors will support but is not required to establish eligibility for hospice care:
• • Treatment–resistant symptomatic supraventricular or ventricular arrhythmias.
• • History of cardiac arrest or resuscitation.
• • History of unexplained syncope.
• • Brain embolism of cardiac origin.
• • Concomitant HIV.
• • Significant congestive heart failure may be documented by an ejection fraction of ≤20% but is not required if not already available.