Hospice Eligibility for Heart Failure (CHF) and other Cardiac Diseases

At Compassus, we value a physician's best clinical judgement for referral. We've included Medicare criteria below. Medical directors at our local Compassus programs are also available for consultation.


Patients will be considered to be in the terminal stage of cardiac disease if they meet the criteria below. Criteria 1 and 2 MUST be present; factors from 3 lend supporting documentation, but are not required.

1. At the time of initial certification or recertification for hospice:

  • Patient is already optimally treated with diuretics and vasodilators, which may include Angiotensin-converting enzyme (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;

    OR

  • Patients having angina pectoris, at rest, resistant to standard nitrate therapy and are either not candidates or decline invasive procedures.

AND

2. The patient has significant symptoms of recurrent congestive heart failure (CHF) at rest, and is classified as a New York Heart Association (NYHA) Class IV.

  • Unable to carry on any physical activity without symptoms;
  • Symptoms are present even at rest;
  • If any physical activity is undertaken, symptoms are increased.

3. Documentation of the following factors may provide additional support for determining prognosis in end stage heart disease:

  • 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;
  • Documentation of ejection fraction of 20% or less (only if available)


If a patient meets the medical criteria above, they are by definition eligible to receive hospice services. Some patients may not meet the criteria, but may still be eligible for hospice care due to comorbidities or rapid functional decline.

Our team helps patients, who have decided on hospice, to manage symptoms during the end stages of heart failure and other heart diseases. We work with patients, families and their medical team to control symptoms at home, reducing or eliminating visits to the emergency room and avoidable hospital readmissions.