Hospice Eligibility Guidelines for End-Stage CHF & Other Heart Disease

Are you a patient, family member, or caregiver? Learn about how VITAS can help patients with end-stage CHF & other heart disease.

Heart disease differs significantly from other illnesses in its course and treatment. Hospice care for advanced cardiac disease addresses a wide range of symptoms, including shortness of breath, chest pain, weakness, functional decline and the management of fluid status.

When is Your Heart Disease Patient Eligible for Hospice Services?

Patients are eligible for hospice care when a physician makes a clinical determination that life expectancy is six months or less if the disease runs its expected course.

Comorbid disease risk factors:

• Hypertension
• Diabetes
• Coronary heart disease
• Family history of cardiomyopathy
• Prior myocardial infarction
• Valvular heart disease

End-stage disease classifications of patients who are hospice-appropriate

Characteristics of end-stage congestive heart disease

• New York Heart Association (NYHA) Class III if any of the following symptoms are present during less-than-normal activity (i.e. patient is comfortable only at rest):
  • Fatigue
  • Palpitations
  • Angina or dyspnea with exercise
• NYHA Class IV as manifested by any of the following symptoms:
  • Dyspnea and/or other symptoms at rest or with minimal exertion
  • Inability to carry out physical activity without dyspnea and/or other symptoms
  • If physical activity is undertaken, dyspnea and/or other symptoms worsen
• The patient is being optimally treated for congestive heart failure with diuretics and vasodilators, such as ACE inhibitors, or they are maximally medically managed and have no available surgical options.

Comorbid heart disease risk factors

• Hypertension
• Diabetes
• Coronary heart disease
• Family history of cardiomyopathy
• Prior myocardial infarction
• Valvular heart disease

Characteristics of end-stage coronary artery disease

• Patient has frequent or recurrent bouts of angina pectoris at rest or with minimal activity.
• Patient is symptomatic despite standard nitrate therapy.
• Patient is not a candidate for (or declines) invasive procedures, such as percutaneous angioplasty or coronary artery bypass surgery.

Comorbid factors:

• Persistent and/or chronic signs and symptoms of congestive heart failure
• Symptomatic supraventricular arrhythmias despite intensive antiarrhythmic therapy
• History of cardiac arrest and resuscitation
• History of syncope from any cause
• Cardiogenic brain embolism
• Concomitant HIV disease
• Renal failure
• COPD
• Cardiovascular accident (CVA, or stroke)
• Liver failure
• Cancer
• Dementia
• Smoking
• Diabetes
• Hypertension
• Elevated cholesterol
• Coronary artery disease
• Age > 75 years

VITAS provides these guidelines as a convenient tool. They do not take the place of a physician's professional judgment.