Cardiac Disease Patients will be considered to be in the terminal stage of cardiac disease if they meet the criteria of BOTH 1 and 2, with 3 providing supporting documentation, but not required. 1. At the time of initial certification or recertification for hospice: a. Patient is already optimally treated with diuretics
         and vasodilators, which may include Angiotensin-converting
         enzyme (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
b. Patients having angina pectoris, at rest, resistant to standard
         nitrate therapy and are either not candidates or decline
         invasive procedures.AND
2. 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. a. Unable to carry on any physical activity without symptoms;
b. Symptoms are present even at rest;
c. If any physical activity is undertaken, symptoms are
         increased.
3. Documentation of the following factors may provide additional support for determining prognosis in end stage heart disease: a. Treatment resistant symptomatic supraventricular or
         ventricular arrhythmias;
b. History of cardiac arrest or resuscitation;
c. History of unexplained syncope;
d. Brain embolism of cardiac origin;
e. Concomitant HIV disease;
f.  Documentation of ejection fraction of 20% or less
If a patient meets the medical criteria above, they are by definition eligible to receive hospice services. Some patients may not meet the criteria, but may still be eligible for hospice care due to comorbidities or rapid functional decline. Contact your Samaritan Care Hospice Consultant for further information.