We understand that navigating the complexities of hospice care can be overwhelming, especially when dealing with heart disease and congestive heart failure. This page aims to provide you with a comprehensive guide to the eligibility guidelines for hospice care specifically designed for individuals facing congestive heart failure and end-stage heart disease.

End-Stage Heart Disease diagnoses may include but are not limited to:

• Congestive Heart Failure (CHF)
• Coronary Artery Disease (CAD)
• Cardiomyopathy
• Valvular Heart Disease

Disease Specific Guidelines

Patients who meet the following criteria will be deemed to be in the terminal stage of heart disease, with a life expectancy of six months or less if the illness runs its course. These criteria apply to patients with different forms of heart disease or CHF who ultimately follow a final common pathway for end-stage disease. The patient should show numbers 1 &2 while number 3 will serve to add supporting documentation.

1. The patient is or has been already optimally treated for heart disease (use of vasodilators/ace inhibitors and/or diuretic use) or is not a candidate for surgical intervention (or has declined a procedure).
2. The patient is categorized as New York Heart Association (NYHA) class IV (Shortness of breath or other symptoms at rest or with minimal effort. Inability to carry out physical activity without shortness of breath and/or other symptoms. Increased symptoms with any level of physical activity). CHF may be documented with an ejection fraction of ≤ 20% but if not already available is not required.
3. Documentation of the following will be supportive but not required to establish hospice eligibility:
   1. History of cardiac arrest or resuscitation
   2. Treatment resistant symptomatic supraventricular or ventricular arrhythmias
   3. History or unexplained syncope (loss of consciousness)
   4. Brain embolism (clot) of a cardiac origin
   5. Concomitant HIV disease
4. Fever, recurrent following antibiotics

Non-Disease Specific Guidelines

1. Physiologic impairment of functional status demonstrated by a score < 70% using either:
   1. Karnofsky Performance Status (KPS)
   2. Palliative Performance Score (PPS)
2. Dependence on assistance for two or more of the following activities of daily living (ADLs):
   1. Feeding
   2. Bathing
   3. Dressing
   4. Toileting
   5. Ambulation (walking/moving)
   6. Transfer

Co-morbidities

Although not the primary hospice diagnosis, the presence of certain co-morbidities should be considered in determining hospice eligibility, as the severity of these conditions is likely to contribute to a life expectancy of six months or less. These co-morbidities may include:

• Chronic obstructive pulmonary disease
• Congestive heart failure
• Ischemic heart disease
• Dementia
• Renal failure
• Diabetes mellitus
• Liver disease
• Acquired immune deficiency syndrome (AIDS)
• Neurologic disease (CVA, ALS, MS, Parkinson’s)
• Neoplasia

Disclaimer: Please note that the information provided on this page is intended for general guidance purposes only and should not replace professional medical advice. Each individual’s situation is unique, and eligibility for hospice care should be assessed by qualified healthcare professionals.