(1 & 2 are required, 3 will act as supporting documentation.)

1. At the time of certification/ recertification for hospice, the patient is or already has been optimally treated for heart disease or is not a candidate for a surgical procedure or has declined a procedure. (Optimally treated = patients not on vasodilators have medical reason for refusing drugs, e.g. hypotension or renal disease.)
2. The patient is classified as New York Heart Association (NYHA) Class IV & may have significant symptoms of heart failure or angina at rest. (Class IV patients w/ 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. The following factors are not required for hospice eligibility but act as supporting documentation:
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