Hospice Eligibility Assessment for Patients with Advanced Heart Failure

Clinical Presentation and Disease Progression

• The European Society of Cardiology recommends that patients with congestive heart failure and a BNP greater than 200 be considered for hospice care due to significant cardiac stress 1
• Patients with oxygen saturations ranging between 80-95% and desaturation upon minimal exertion may be eligible for hospice care 2
• The American College of Cardiology suggests that dyspnea with minimal exertion, requiring patients to sleep in a lounge chair due to inability to tolerate supine position, is a hallmark symptom of advanced heart failure 3, 4
• Lower extremity edema, suggesting ongoing volume management challenges, is a common comorbidity in patients with advanced heart failure 3

Functional Status and Palliative Care Needs

• A Palliative Performance Scale (PPS) of 50% or lower indicates significant functional decline and may be an indicator for hospice eligibility 1
• Dependence for activities of daily living (ADLs), including bathing requiring supervision, is a common characteristic of patients eligible for hospice care 4
• Mobility limitations, requiring a walker and 1-2 person assist with transfers, increase the risk of falls and may indicate a need for hospice care 5
• High fall risk, with 2 or more falls in the past 60 days, is a significant concern for patients with advanced heart failure and may require specialized care 4

Symptom Management and Medication Adjustments

• Dyspnea management may require continued diuretics and potentially opioids for refractory symptoms, according to the American College of Cardiology 3, 7
• The European Society of Cardiology recommends careful medication management to balance symptom control with quality of life 4
• Anxiety management related to breathlessness is an important aspect of palliative care for patients with advanced heart failure 7

Communication Guidance and Healthcare Team Coordination

• The American College of Cardiology suggests that acknowledging the unpredictable trajectory of heart failure and preparing for declining function is essential for family discussions 8
• Discussing goals of care, focusing on comfort and quality of life, is a crucial aspect of hospice care, according to the European Society of Cardiology 6
• Ensuring care plans are accessible to all providers involved and establishing clear communication channels for symptom changes is vital for coordinated care 8, 5