Hospice Clinical Appropriateness: End-Stage Heart Disease
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Heart disease differs significantly from other illnesses in its course and approaches to treatment. Hospice care for heart disease is designed for the treatments of a wide range of symptoms including shortness of breath, chest pain, weakness, functional decline, as well as the management of fluid status.
Knowing when a heart disease patient is ready for hospice care
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:
- 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
- NYHA Class III if any of the below symptoms are present with less than normal daily activities (i.e. comfortable only at rest):
- Angina or dyspnea with exercise
- NYHA Class IV as manifested by any of the below:
- Dyspnea and/or other symptoms at rest or with minimal exertion
- Inability to carry on 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 surgical options available to them.
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
- Persistent and/or chronic signs and symptoms of chronic congestive heart failure
- Symptomatic supraventicular arrythmias despite intensive antiarrythmic therapy
- History of cardiac arrest and resuscitation
- History of syncope from any cause
- Cardiogenic brain embolism
- Concomitant HIV disease
- Renal failure
- Liver failure
- 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.