Heart Disease

Heart Disease

Heart Disease

LCD Guideline Heart Disease

1. At the time of initial certification or recertification for hospice, the patient is or has been already optimally treated for heart disease or is not a candidate for a surgical procedure or has declined a procedure. (Optimally treated means that patients who are not on vasodilators have a medical reason for refusing these drugs, e.g., hypotension or renal disease.)

2. The patient is classified as New York Heart Association (NYHA) Class IV and may have significant symptoms of heart failure or angina at rest. (Class IV patients with heart disease have an inability to carry on any physical activity without discomfort. Symptoms of heart failure or of the angina syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased.) Significant congestive heart failure may be documented by an ejection fraction of ≤20% but is not required if not already available.

3. Documentation of the following factors will support but is not required to establish eligibility for hospice care:

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

Comparative Date

Change in Activity - Patient was going to activity daily now stays in room. Was able to walk down the hall now unable to walk more than 5 feet.

Change in Breathing – Patient is now using purse lip breathing, labored breathing

Increase in SOB - Patient was able to walk down the hallway without oxygen. Patient is now using oxygen and is only able to ambulate15 feet without resting

Pain - Increase in pain medications, chest pain noted with activity

Anxiety - Patient gets very anxious when short of breath. Patient states “I get very nervous when I can’t breathe”

Edema - Previously no edema noted, now edema noted in feet and ankles

Change in weight - Patient has gained 5lbs in 5 days related to edema

Depression - Patient is withdrawn, does not engage in activity

Intake - Patient complains of feeling full but is only eating 25% of meal. Patient was eating 100% of meal and now only eating 50%

Change in ADL’s - Patient was previously stand by assist with bathing; now is a one person assist

Medication changes - We have changed Lasix every week Comorbidities Kidney failure Pain SOB Syncopal Episodes Anorexia Ascites Edema Weight Gain COPD Pulmonary Fibrosis

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