End-Stage Heart Disease:
Guidelines for End-Stage Heart Disease & Related Disorders

LIFE LIMITING CONDITION AS EVIDENCED BY:

• Documentation of clinical progression of disease evidenced by:
  • Physician assessment.
  • Laboratory studies.
  • Multiple ER visits & Inpatient hospitalizations.
  • Radiologic or other studies.

AND/OR:

• The patient is already optimally treated with diuretics and vasodilators, which may include:
  • Angiotensin-converting enzymes (ACE) inhibitors or the combination of hydralazine and nitrates. If side effects, such as hypotension or hyperkalemia, prohibit the use of ACE inhibitors or the combination of hydralazine and nitrates, this must be documented in the medical records.
  • Patient is having angina pectoris, or dyspnea with minimal exertion, resistant to standard nitrate therapy & are either not candidates or decline invasive procedures.
• Symptoms may present at rest.
• The patient has significant symptoms of recurrent congestive heart failure (CHF) despite optimal treatment.

DOCUMENTATION OF THE FOLLOWING FACTORS MAY PROVIDE ADDITIONAL SUPPORT FOR END-STAGE HEART DISEASE:

• Treatment resistant symptomatic supraventricular or ventricular arrhythmias.
• Documentation of ejection fraction of 20% or less.
• History of cardiac arrest or resuscitation.
• Brain embolism of cardiac origin.
• History of unexplained syncope.
• Concomitant HIV disease.

HOW WE HELP — END-STAGE HEART DISEASE:

• Increased quality of life.
• Medication to relieve symptoms such as pain or shortness of breath.
• Coordination of comfort measures for patient including durable medical equipment and non-medical therapies.
• Education for the patient and family as disease progresses.
• Psychosocial support for patient and the family.
• Spiritual care and support for the patient and the family.