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.

NYHA Functional Classification Scale