Congestive Heart Failure (CHF) and End-Stage Heart Disease: What to Expect

In the advanced stages of heart disease including CHF, individuals can experience a range of physical and emotional challenges. As the heart becomes weaker, its ability to pump blood effectively is compromised, leading to symptoms such as severe fatigue, shortness of breath even at rest, persistent coughing, fluid retention causing swelling in the legs, ankles, or abdomen, and difficulty performing daily activities like bathing, dressing, using the restroom, and even moving. End-stage CHF often requires frequent hospitalizations and intensive medical interventions, including medication adjustments, diuretics to manage fluid buildup, and the possibility of advanced treatments like implantable devices or heart transplant evaluation. Additionally, the emotional impact of living with end-stage heart disease can be significant, with feelings of anxiety, sadness, and uncertainty. It is crucial for individuals with end-stage heart disease and their families to have a comprehensive support system that includes medical professionals, palliative care specialists, and emotional support to ensure the best possible quality of life during this challenging phase.

During the end-stage of heart disease, when medical interventions are no longer able to provide a cure, hospice care can offer a compassionate and supportive approach. Hospice focuses on providing comfort, pain management, and emotional support to patients and their families, ensuring dignity and quality of life during this difficult time. With a multidisciplinary team of healthcare professionals, including doctors, nurses, social workers, and spiritual counselors, hospice can provide specialized care tailored to the individual’s needs, offering relief from physical symptoms, and addressing the emotional and spiritual well-being of both the patient and their loved ones. Choosing hospice care can bring a sense of comfort and peace, allowing patients to spend their remaining time in a familiar and supportive environment surrounded by their loved ones.

Hospice Eligibility Guidelines for Individuals with Heart Disease and Congestive Heart Failure (CHF)

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


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.


Benefits of Hospice Care for Individuals with CHF and End-Stage Heart Disease:

Hospice care offers numerous benefits tailored to the specific needs of individuals with CHF and end-stage heart disease. Some of these benefits include:

1. Pain and Symptom Management: Hospice care focuses on alleviating pain and managing distressing symptoms associated with end-stage heart disease.

For those with end-stage heart conditions this can include managing symptoms commonly experienced which may include:

  • Shortness of breath
  • Cough
  • Edema/swelling
  • Fatigue
  • Weakness
  • Pain
  • Cognitive decline
  • Sleep disturbance
  • Agitation
  • Decreased nutrition and weight loss

The interdisciplinary team, including physicians, nurses, respiratory therapists, social workers, and chaplains, work together to develop a comprehensive plan that addresses the unique needs of each patient.

2. Medication and Equipment Support: Hospice provides medications, oxygen, and other necessary equipment (mobility aides, hospital bed, etc.) related to managing the symptoms that may arise with end-stage heart disease. This ensures that patients have access to the resources they need to maintain comfort and improve their quality of life. All medications and durable medical equipment related to the terminal condition are covered under the hospice benefit.

3. Emotional and Psychosocial Support: Hospice care extends support not only to patients but also to their families and caregivers. Helping a loved one with end-stage heart disease can be challenging. Social workers and counselors are available to provide emotional support, counseling, and resources to cope with the challenges that arise during this difficult time. The nursing team is available to assist in educating and guiding you through providing the best care to your loved one with heart disease and CHF.

4. Skilled Nursing Care: Hospice care includes skilled nursing services provided by specially-trained hospice nurses who have expertise in managing the complexities of CHF and heart disease. These skilled nurses assess and monitor the patient’s condition, provide anticipatory guidance based on disease progression, educate the patient and caregivers, manage medications, provide wound care if needed, and collaborate with other healthcare professionals to ensure comprehensive care.

5. Assistance with Activities of Daily Living (ADLs): Nurse aides, also known as certified nursing assistants (CNAs), are an integral part of the hospice team. They provide hands-on assistance with activities of daily living (ADLs), such as bathing, dressing, grooming, and toileting. For individuals with heart disease and congestive heart failure who may experience shortness of breath, easy fatigue, chest pain, and physical limitations due to disease progression, nurse aides help maintain personal hygiene, promote comfort, and preserve dignity.

6. 24/7 Access to Care: Hospice care offers round-the-clock access to the hospice team, providing peace of mind for patients and their families. This availability ensures that assistance is available whenever it is needed, even outside regular office hours.

7. Spiritual and Bereavement Support: Hospice care acknowledges the importance of spiritual and emotional well-being during end-of-life care. Chaplains or spiritual counselors are available to provide spiritual support, and bereavement services are offered to help families cope with grief and loss after the passing of a loved one.

8. Self-guidance: An individual is allowed to receive care in their preferred setting and have input on their care allowing for an increased sense of comfort.

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Not sure if you or a loved one are eligible to receive hospice care?

Contact the Honor Hospice team for an evaluation to determine if hospice is an appropriate care option.

If you have any questions regarding hospice eligibility guidelines for individuals with end-stage heart disease, please feel free to contact us. Our compassionate team at Honor Hospice is dedicated to providing information, support, and personalized care during this challenging time.

Take the first step towards compassionate care and learn how hospice can make a difference in your life or the life of your loved one.