CARDIOVASCULAR DISEASE

The patient has:

• Poor response to optimal treatment with diuretics and vasodilators, including angiotensin converting enzyme (ACE) inhibitors and
• The presence of significant symptoms of recurrent congestive heart failure (CHF) at rest and classified as New York Heart Association (NYHA) Class IV (inability to carry on any physical activity without discomfort, symptoms of heart failure or anginaat rest or increased discomfort even with minimal exertion

Supporting documentation:

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

A physician may determine that a patient has a life expectancy of six months or less even if the above findings are not present. Co-morbidities also support eligibility for hospice care.

New York Association (NYHA) Functional Classification

This scale assists in the determination of functional ability in patients with cardiac disease.

Class I	Patients with cardiac disease, but without resulting limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea, or anginal pain.
Class II	Patients with cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea or anginal pain.
Class III	Patients with marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes fatigue, palpitation, dyspnea, or anginal pain.
Class IV	Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of heart failure or of the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased.