Hospice Care Admission Guidelines for Heart Disease
LCD Guidelines
Heart Disease
(1 & 2 are mandatory, while 3 serves as supplementary documentation.)
- At the time of certification or recertification for hospice care, the patient has either already received the best possible treatment for heart disease, is not suitable for a surgical procedure, or has opted to decline the procedure. (Best possible treatment refers to patients who are not on vasodilators due to valid medical reasons, such as hypotension or kidney disease.)
- The patient is classified under New York Heart Association (NYHA) Class IV and may experience severe symptoms of heart failure or angina even at rest. (Class IV heart disease patients are unable to perform any physical activity without discomfort. They may experience heart failure symptoms or angina while resting, with discomfort worsening upon any form of activity.) Severe congestive heart failure can be documented by an ejection fraction of 20% or lower, though this is not a strict requirement if the information is unavailable.
- While not mandatory for hospice eligibility, the following factors may provide additional supporting evidence:
- Supraventricular or ventricular arrhythmias that do not respond to treatment
- A history of cardiac arrest or successful resuscitation
- A history of unexplained fainting (syncope)
- Brain embolism originating from the heart
- Coexisting HIV infection
Comparative Data
Activity Level: The patient, who used to attend daily activities, now remains in their room. They were once able to walk down the hallway but can now only walk up to five feet.
Breathing Difficulty: The patient now exhibits pursed-lip breathing and labored breaths.
Increased Shortness of Breath (SOB): Previously able to walk down the hallway without oxygen, the patient now requires oxygen and can only walk about 15 feet before needing to rest.
Pain: There has been an increase in pain medication use, and the patient experiences chest pain during activities.
Anxiety: The patient becomes highly anxious when experiencing shortness of breath, often stating, “I get very nervous when I can’t breathe.”
Edema: While previously not present, edema is now noticeable in the feet and ankles.
Weight Gain: The patient has gained five pounds in the last five days, likely due to fluid retention related to edema.
Depression: The patient has become more withdrawn and no longer participates in activities.
Decreased Food Intake: The patient complains of feeling full and is now only eating 25% of their meals. Previously, they consumed 100% of their meals, but this has decreased to 50%.
Changes in ADLs: Where the patient once only required standby assistance for bathing, they now need one-person assistance.
Medication Adjustments: Lasix has been adjusted weekly to address the patient’s condition.
Comorbidities
- Kidney Failure
- Pain
- SOB
- Syncopal Episodes
- Anorexia
- Ascites
- Infections
- Weight Gain
- COPD
- Pulmonary Fibrosis
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