Poor response to (or patient's
choice not to pursue) optimal treatment with diuretics, vasodilators,
and/or angiotensin converting enzyme (ACE) inhibitors
OR
2.
The
patient has angina pectoris at rest resistant to standard nitrate
therapy and is not a candidate for invasive procedures and/or
has declined revascularization procedures.
AND
3.
New York Heart Association (NYHA) Class IV symptoms
with both of the following:
The presence of significant symptoms of recurrent
Congestive Heart Failure (CHF) and/or angina at
rest
Inability
to carry out even minimal physical activity without
symptoms of heart failure (dyspnea) or angina
AND
4.
Documentation to support eligibility
Echo demonstrating an ejection fraction
of 20% or less
Treatment
resistant symptomatic dysrythmias
History
of unexplained or cardiac related syncope
CVA
secondary to cardiac embolism
History
of cardiac arrest or resuscitation
In the absence of
one or more of the above findings, rapid
decline or comorbidities may also support
eligibility for hospice care.
