Prognosis of Heart Disease Based On Hospice Admission Criteria

What follows is the prognosis for heart disease based on hospice admission criteria. If a patient meets these criteria he or she is eligible for hospice care which means that he or she has six months or less to live.

To meet the CMS Disease Specific Criteria For terminal (less than 6 months) heart disease, the patient must meet the following:

A patient is eligible for hospice services if he
meets these three criteria:
1) has a Palliative Performance Scale of less than 70% [Resource (2)]
2) is dependent on at least two Activities of Daily Living [Resource (3), and
3) meets the Disease Specific Guideline for heart disease [Resource (1)] below:

Heart Disease

Patients will be considered to be in the terminal stage of
heart disease (life expectancy of six months or less) if they
meet the following criteria. (1 and 2 should be present.
Factors from 3 will add supporting documentation.)

1. At the time of initial certification or recertification for
hospice, the patient is or has been already optimally
treated for heart disease, or are patients who are either not
candidates for surgical procedures or who decline those
procedures. (Optimally treated means that patients who
are not on vasodilators have a medical reason for refusing
these drugs, e.g., hypotension or renal disease.)

2. Patients with congestive heart failure or angina should
meet the criteria for the New York Heart Association
(NYHA) Class IV. (Class IV patients with heart disease have
an inability to carry on any physical activity. Symptoms
of heart failure or of the anginal 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 less than or
equal to 20%, but is not required if not already available.

3. Documentation of the following factors will support but
is not required to establish eligibility for hospice care:
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.


1. Determining Hospice Eligibility In Terminally Ill Patients Hospice by The Bay – An Affiliate Of USCF Health, Updated 3-2014

2. The Palliative Performance Scale For Determination Of Hospice Eligibility
Posted on March 29, 2018 by Tom Wade MD

3. Instruments For The Assessment Of The Activities Of Daily Living [ADLs]
Posted on March 30, 2018 by Tom Wade MD

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