Significant symptoms of recurrent congestive heart failure (CHF) at rest.
Classification as New York Heart Association (NYHA) Class III or IV.
The following are not required, but support a hospice referral:
Patient is already optimally treated with diuretics and vasodilators, which may include angiotensin-converting enzymes (ACE) inhibitors or the combination or hydrazine and nitrates. If the side effects, such as hypotension or hyperkalemia, prohibit the use of ACE inhibitors or the combination of hydrazine and nitrates, this must be documented in medical records.
Patients must have angina pectoris, at rest, resistant to standard nitrate therapy and are either not candidates or decline invasive procedures.
History of cardiac arrest
Treatment resistant symptomatic supraventricular or ventricular arrhythmias
Brain embolism of cardiac origin
History of unexplained syncope
Concomitant HIV disease
Documentation of ejection fraction of 20% or less.