Hospice Eligibility Guidelines for Patients with Heart Disease

Ultimately, hospice eligibility is centered on a physician's clinical judgment. If a physician believes the patient will likely live six months or less if the disease follows its natural course, then the patient is considered hospice eligible. Eligibility is based on the severity of the patient’s primary diagnosis (the diagnosis contributing most to terminality), as well as secondary/comorbid conditions and nutritional/functional status. In some cases, the primary diagnosis alone is sufficiently advanced to make a patient hospice eligible. This determination is made with the help of disease severity guidelines called Local Coverage Determinations (LCDs) listed below:

NYHA Class IV [symptom(s) at rest]

Symptomatic despite maximal medical management with diuretics and vasodilators

Arrhythmias resistant to treatment are not a requirement, but they help support the diagnosis for hospice-eligible heart disease